dissabte, 17 de desembre de 2011

Per les "traumatologues"

December 07, 2011
Occupational Hazards to the Pregnant Orthopaedic Surgeon
J Bone Joint Surg Am.  2011;93(23):E141 1-5  doi:10.2106/jbjs.k.00061
Roxanne R. Keene, MD; Diane C. Hillard-Sembell, MD;
Article a tenir en compre per les companyes que volen tenir fills. Un recull de les possibles problematiques que la nostre professio ocasiona en el moment de l'embaraç.

FELIZ NAVIDAD

Hola a todos.
Soy Ana Morales.
Os escribo un pequeño mensaje para desearos FELIZ NAVIDAD a todos.
Estoy muy contenta. Trabajando muchísimo y aprendiendo lo que más me gusta; así que no se puede estar mejor!!!


Si bajais por Valencia y os apetece que nos veamos, sólo tenéis que avisar. Algunas ya lo han hecho.

Un beso y un abrazo enorme.


dimecres, 30 de novembre de 2011

Fijador externo supraacetabular

Fijador externo supraacetabular para el tratamiento de las fracturas de anillo pélvico
Axel Gänsslena ,Tim Pohlemannb y Christian Kretteka
Tec. Quir. Ortop. Traumatol. (ed. esp.) Vol. 15 núm. 2, 2006
 
Article interessant , tècnica quirurgica de colocaco de les tijes.


























 

dilluns, 28 de novembre de 2011

VoyantWeb

Us pot interessar......................


https://orthoweb.secure.force.com/VoyantLink/

http://www.voyanthealth.com/downloads/MK3U00343_C_OrthoResidents_Brochure.pdf


VoyantWeb is a suite of integrated cloud technologies, from providers such as Salesforce.com and Amazon.com, that deliver medical-image sharing, workflow, and planning tools to hospitals, clinics, imaging centers, and physicians. VoyantWeb allows you to access and use tools “in the cloud”—no need to purchase and install complex and monolithic software, making them widely accessible and affordable to use.

May be the future?

dimecres, 9 de novembre de 2011

Decidir quan un tractament Q en fractures d'espatlla...

Interessant article:
Hemiarthroplasty versus nonoperative treatment ofdisplaced 4-part proximal humeral fractures in elderly patients: a randomized controlled trial.

Olerud, MDa,*, Leif Ahrengart, MD, PhDa, Sari Ponzer, MD, PhDa,Jenny Saving, MDa, Jan Tidermark, MD, PhDa,b.
aKarolinska Institutet, Department of Clinical Science and Education, Section of Orthopaedics, Stockholm S€oder Hospital,Sweden bDepartment of Orthopaedics, Capio St G€orans Hospital, Stockholm, Sweden

Background: The aim of the study was to report the 2-year outcome after a displaced 4-part fracture of the
proximal humerus in elderly patients randomized to treatment with a hemiarthroplasty (HA) or nonoperative
treatment.
Patients and Methods: We included 55 patients, mean age 77 (range, 58-92) years, 86% being women. Follow-up examinations were done at 4, 12, and 24 months. The main outcome measures were healthrelated quality of life (HRQoL) according to the EQ-5D and the DASH and Constant scores.

Results: At the final 2-year follow-up the HRQoL was significantly better in the HA group compared to the
nonoperative group, EQ-5D index score 0.81 compared to 0.65 (P¼.02). The results forDASHand pain assessment were both in favor of the HA group, DASH score 30 versus 37 (P ¼.25) and pain according to VAS 15 versus 25 (P ¼.17). There were no significant differences regarding the Constant score or range of motion (ROM). Both groups achieved a mean flexion of approximately 90-95º and a mean abduction of 85-90º.The need for additional surgery was low: 3 patients in the HA group and 1 patient in the nonoperative group.

Conclusion: The results of the study demonstrated a significant advantage in quality of life in favor of HA,
as compared to nonoperative treatment in elderly patients with a displaced 4-part fracture of the proximal
humerus. The main advantage of HA appeared to be less pain while there were no differences in ROM.

Level of evidence: Level I, Randomized Controlled Trial, Treatment Study.

2011 Journal of Shoulder and Elbow Surgery

divendres, 21 d’octubre de 2011

AAOS Guideline on The Treatment of Osteoporotic Spinal Compression Fractures

AAOS Guideline on The Treatment of Osteoporotic Spinal Compression Fractures
Summary of Recommendations
The following is a summary of the recommendations in the AAOS’ clinical practice guideline, The Treatment of Symptomatic Osteoporotic Spinal Compression fractures. This summary does not contain rationales that explain how and why these recommendations were developed nor does it contain the evidence supporting these recommendations. All readers of this summary are strongly urged to consult the full guideline and evidence report for this information. We are confident that those who read the full guideline and evidence report will see that the recommendations were developed using systematic evidence-based processes designed to combat bias, enhance transparency, and promote reproducibility.
This summary of recommendations is not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, and other healthcare practitioners.
We suggest patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms suggesting an acute injury (0 to five days after identifiable event or onset of symptoms) and who are neurologically intact be treated with calcitonin for four weeks.
Strength of Recommendation: Moderate
Ibandronate and strontium ranelate are options to prevent additional symptomatic fractures in patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms.
Strength of Recommendation: Weak
We are unable to recommend for or against bed rest, complementary and alternative medicine, or opioids/analgesics for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
It is an option to treat patients who present with an osteoporotic spinal compression fracture at L3 or L4 on imaging with correlating clinical signs and symptoms suggesting an acute injury and who are neurologically intact with an L2 nerve root block.
Strength of Recommendation: Weak
We are unable to recommend for or against treatment with a brace for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against a supervised or unsupervised exercise program for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against electrical stimulation for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Inconclusive
We recommend against vertebroplasty for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Strong
Kyphoplasty is an option for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are neurologically intact.
Strength of Recommendation: Weak
We are unable to recommend for or against improvement of kyphosis angle in the treatment of patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms.
Strength of Recommendation: Inconclusive
We are unable to recommend for or against any specific treatment for patients who present with an osteoporotic spinal compression fracture on imaging with correlating clinical signs and symptoms and who are not neurologically intact.
Strength of Recommendation: Inconclusive

dijous, 20 d’octubre de 2011

Web interessant torniquets

Si mai esteu de guàrdia i teniu el dubte existencial de com posar correctament un torniquet...us deixo l'enllaç a aquesta web: http://www.tourniquets.org/.
Ha sigut el tema de la sessió de residents d'avui 20/10/2011

Vagi bé

dilluns, 19 de setembre de 2011

Sessions properes importants

Divendres 23 de setembre a les 8h (Auditori Taulí): I Reunió conjunta dels serveis de COT de Terrassa (CST), Mollet i Taulí . Hem previst per a aquesta primera reunió dues sessions de residents (una nostra i una de Terrassa), presentarem el projecte d'associació de serveis (objectius,..) i després farem un senzill esmorzar. Si us plau a les 8h a l'Auditori per iniciar la sessió.


Divendres 23 de setembre a les 14'30h : reunió d'especialistes de genoll de l'àrea de Barcelona. Es tracta de la reunió periòdica (trimestral) d'un grup obert d'especialistes de genoll que va néixer fa 3 anys. Una sessió de discussió de casos clínics de genoll i és oberta a tothom que hi estigui interessat.

dilluns, 22 d’agost de 2011

APPS surgical reference AO Trauma

Quasi tots ja teniu o un iphone o un mobil amb SO android . Aqui , pels qui no ho tingueu , la referencia de la pagina de la AOTrauma "Surgical reference" per accedir-hi des de el smartphone.



dimarts, 9 d’agost de 2011

Benvinguda

Des de aqui la benvinguda al Dr. Aldo Velasco ja restablert . Tot un exemple per a tots.

Ah i aprofito...
S'han de entregar les avaluacions del juny!!

dilluns, 20 de juny de 2011

Enquesta dels Residents

Aqui teniu una carta de la Secre de Docència:
L'agència de Qualitat del Sistema Nacional de Salut, en el marc del Pla d'auditories docents 2011, vol medir la satisfacció dels residents de la CSPT a traves d'una enquesta. A continuació adjunto un correu en el que s'explica com accedir a aquesta, on reenviar-la (a Docència no) i el plaç màxim d'entrega que es el dia 1 de Juliol 2011.

Rotacio externa de Ortopèdia Infantil a la Vall Hebron

Hi ha un reglament nou per tal de preparar les rotacions al Vall Hebron.Cal fer la peticio ( per tal de ser admesos ) 3 mesos abans mínim. El consell es preparar-ho un any abans `per tal de tenir una segona oportunitat en el cas que ens diguin que no.

divendres, 20 de maig de 2011

SCCOT

És la primera vegada que escric algo així i no només un comentari com ja he fet altres vegades, o sigui, que a veure si es veu.
Voldria felicitar el nostre company Dr. villamil per al exposició que ha fet al congrès SCCOT a la meva humil ciutat. Sobretot, no només en la seva exposició clara i concisa, sinó, sobretot en la manera tan elegant que ha tingut responent la pregunta dels, a vegades maquiavèlics, companys adjunts d ela raspa.
Moltes felicitats Carlos!!!
Marc

dilluns, 18 d’abril de 2011

Resident work-hour regulations

The Increased Financial Burden of Further Proposed Orthopaedic Resident Work-Hour Reductions  Atul F. Kamath, MD
The Journal of Bone and Joint Surgery (American). 2011;93:e31.doi:10.2106/JBJS.I.01676

  .....The landscape of the orthopaedic workforce is changing. An aging population, rising obesity rates, greater lifestyle expectations, and technologic advances are increasing the demand for musculoskeletal services. At the same time, teaching institutions are under strain amidst resident work-hour regulations and the need to balance patient care and education. These goals collide in today's economic climate. As lawmakers, patient advocates, and academic centers consider implementation of further resident work-hour restrictions, the fiscal viability of these proposals remains unknown.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) reduced resident duty hours to no more than eighty hours per week, averaged over a four-week period. The ACGME implemented these limits out of concern that resident fatigue endangered patients and the residents themselves. The regulations were rooted in the 2001 New York State mandate. A growing body of literature underscores the benefits and shortfalls of reduced resident work hours on patient safety  resident morale, quality of life, and education and operative experience. One factor not often discussed is the financial impact of the reduced hours—to our knowledge, no study has evaluated the economic impact of reduced hours in orthopaedic resident education.

Early research on the duty limits shows resident fatigue is still a major problem. This prompted the Institute of Medicine in December 2008 to suggest further work-hour modification, while other discussions of resident work hours have included reductions to as low as fifty-six hours. Furthermore, some state legislators have discussed criminalizing duty-hour violators. Residents in other countries, such as the United Kingdom, Denmark, New Zealand, and France, work between thirty-seven and seventy-two hours per week. However, physician labor-supply shortages and insufficient training are a problem in these countries.

In light of these calls for additional duty limits, we examined the economic implications of a fifty-six-hour work-week regulation for orthopaedic training programs. Through the use of pilot-survey data, we undertook a cost-sensitivity analysis. Our hypothesis, based on workforce data after the eighty-hour work-week restrictions, was that the economic impact of furthered reduced hours, especially if not funded by the government, may make the orthopaedic resident workforce unsustainable...


Curiós com a l'hora de canviar els horaris dels residents a USA ja calculen el efecte en hores de treball de mes que s'hauran de contractar als hospitals docents  i , que si les ha de pagar l'administració pot ser insostenible...mentre que aquí s'han reduït les hores, es possible que minvi la formació pràctica i de contractar ni "hablar".
Per cert allà els resis fan des de 2003 unes 80 h per setmana unes 3200h. al any per assolir una formació correcte.

dijous, 14 d’abril de 2011

SEPTIMA EVALUACIÓN FINAL VOLUNTARIA MIR

L'Anna i en  Rubén tenen la opció de presentar-se al examen final voluntari del MIR. Crec que es una molt bona opció per tal de saber el nivell personal adquirit. Jo ho faria es un repte personal. Us animo a fer-ho.
............................................................................ 

SEPTIMA EVALUACIÓN FINAL  VOLUNTARIA MIR
Oviedo, 26 y 27 de septiembre de 2011

SOLICITUDES:
Podrán presentarse a la misma los residentes y especialistas que hayan finalizado su formación antes de la fecha de realización de la misma.
Las solicitudes deberán enviarse a la secretaría del Consejo Nacional bien por correo ordinario o bien por correo electrónico: Dirección:
Ministerio de Sanidad y Política Social.

Secretaría del Consejo Nacional de Especialidades Sanitarias
Atención. Doña Raquel Herguera.
Pº del Prado 18-20, planta 6º
Madrid – 28014.
E-mail: rherguera@msps.es
Los solicitantes deberán enviar los siguientes datos:
 
Nombre y apellidos, dirección particular, teléfono, teléfono 
móvil y dirección de correo electrónico habitual donde puedan ser localizados a partir del 1 de julio de 2011.Unidad docente en la que se han formado.  
Plazo máximo de inscripción: 30 de junio de 2011. 
PROCEDIMIENTO:
Las pruebas consistirán en una evaluación de competencias, siguiendo directrices del Real Decreto 3176. BOE-45 de 21-2-08, mediante: 
a)    Cuestionario de conocimientos con preguntas de respuesta múltiple.
b)    Recorrido por seis estaciones interactivas de evaluación para análisis y discusión de casos clínicos tipo (fundamentos científicos de la especialidad, cirugía ortopédica infantil, cirugía del raquis, miembro superior, miembro inferior reconstrucción, miembro inferior trauma
Los participantes en la prueba recibirán el resultado de la misma con carácter personal y confidencial. Aquellos que superen satisfactoriamente recibirán un diploma acreditativo de la Dirección General de Recursos Humanos del Ministerio de Sanidad y Consumo
LUGAR: 
La prueba se celebrará  los días 26 y 27 de septiembre de 2011, días previos  al inicio del 48º Congreso SECOT  en:
Palacio de Exposiciones y Congresos Ciudad de Oviedo
Jose Ramon Zaragoza, 8 - 10
Campo de las Naciones 33010 - Oviedo.

divendres, 8 d’abril de 2011

Nous Residents de COT

Benvinguda als nous Residents del Servei , La Núria i el Ferràn

Creo que es interesante...

''Fractures of the Fingers Missed or Misdiagnosed on Poorly Positioned or Poorly Taken Radiographs: A Retrospective Study.''


J Trauma. 2011 Mar 3.

diumenge, 20 de març de 2011

Consentiments informats. SECOT

En aquest link. trobareu els consentiments informats que la Societat Esp. de COT aconsella. Fins i tot un programa per posar-los al pc.
http://www.secot.es/Menu/SECOT/Documentacion-Medica/Consentimiento-informado.aspx

dijous, 17 de març de 2011

engineering orthopedic tissues

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2817661/

While a wide variety of approaches to engineering orthopedic tissues have been proposed, less attention has been paid to the interfaces, the specialized areas that connect two tissues of different biochemical and mechanical properties. The interface tissue plays an important role in transitioning mechanical load between disparate tissues. Thus, the relatively new field of interfacial tissue engineering presents new challenges—to not only consider the regeneration of individual orthopedic tissues, but also to design the biochemical and cellular composition of the linking tissue. Approaches to interfacial tissue engineering may be distinguished based on if the goal is to recreate the interface itself, or generate an entire integrated tissue unit (such as an osteochondral plug). As background for future efforts in engineering orthopedic interfaces, a brief review of the biology and mechanics of each interface (cartilage–bone, ligament–bone, meniscus–bone, and muscle–tendon) is presented, followed by an overview of the state-of-the-art in engineering each tissue, including advances and challenges specific to regenerating the interfaces.

dimarts, 1 de març de 2011

Tutorials per apendre "Recercar" info.

Per qui vulgui apendre a fer anar el cercador Pub-Med ( alias Medline ) hi ha una plana de tutorials que som molt interessants.

Congresos SECOT

http://www.congresos-secot.com/cursos_2011.html
Aquest link us portara als corsos de la SECOT. Estan orientats en bàsics i avançats. Es interessant que els comenteu amb els tutors per intentar de distribuir-los durant l'any.

JHuguet

dilluns, 28 de febrer de 2011

divendres, 4 de febrer de 2011

La anatomia de Google.

De la mateixa manera que google maps o heart ara google body mostra el cos huma per capes. Us cal el seu navegador Google Chrome ó un Firefox 4 beta.
No es que tingui una gran finura de detall pero pot ser útil per fer un esquema anatòmic i localitzar a grosso modo una regio.




Si voleu treure la imatge que esteu veient  recordeu la tecla Imp Pnt ( imprimir pantalla ) i tot seguit "pegar" en el mateix power point ó en un programa de dibuix per retocar-ho.

divendres, 21 de gener de 2011

HISTÒRIA

Filmacions de la edat de pedra de la Trauma

Aqui teniu un vídeos interesantisims per que us en adoneu de com han canviat en pocs anys les tècniques de les ciències mèdiques.
Ja a principis del segle 20 s'utilitzaven les noves tech. (cinema) com a medi de propagació del coneixement.

Sir Reginal Watson Jones

humer /Lorenz Böhler

clavicula/ Lorenz Böhler

Els peus
http://www.youtube.com/watch?v=I2D_3zcMJ1Y

divendres, 14 de gener de 2011

A comparison of hemiarthroplasty with total hip replacement

Es l'article del Xavi a la bibligràfica de dilluns. Interessant per que hi han pocs estudis randomitzats al respecte.

A comparison of hemiarthroplasty with total hip replacement for displaced intracapsular fracture of the femoral neck. A RANDOMISED CONTROLLED MULTICENTRE TRIAL IN PATIENTS AGED 70 YEARS AND OVER
M. P. J. van den Bekerom,  E. F. Hilverdink,
Academic Medical Center, Amsterdam
JBJS, Br. VOL. 92-B, No. 10, OCTOBER 2010
Because of a higher intra-operative blood loss (p < 0.001), an increased duration of the operation (p < 0.001) and a higher number of early and late dislocations (p = 0.002), we do not recommend THR as the treatment of choice in patients aged ≥ 70 years with a fracture of the femoral neck in the absence of advanced radiological osteoarthritis or rheumatoid arthritis of the hip...
Ara solament falta que trobem una forma de minimitzar la usura del còtil ( 10%) i cap mes total... 



Gràcies Solernou, article molt interesant.

JHB