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La inyección de alta presión en la mano causa una pequeña lesión cutánea pero severo daño tisular subcutáneo que puede provocar pérdida funcional permanente o amputación. Un tratamiento urgente y adecuado es determinante. Presentamos el caso de un pintor industrial que se inyectó pintura con base de aceite con su pistola de alta presión en el dedo índice izquierdo. Ingresó en Urgencias, donde se le administró profilaxis antitetánica y antibioterapia intravenosa y, antes de transcurridas cuatro horas, se le realizó un desbridamiento quirúrgico. Al año de la lesión el paciente presentaba movilidad activa y pasiva del dedo completa con palidez cutánea, hipersensibilidad y disfunción con la exposición al frío. Hay que reconocer la severidad de estas lesiones con apariencia inicial benigna y realizar un amplio desbridamiento quirúrgico inmediato de todo el tejido isquémico, ya que el retraso en realizarlo se asocia con altas tasas de complicaciones

High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were administered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication

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High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were adminis-tered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication. Keywords. High-pressure injuries. Paint injection. Hand. Management.

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OBJECTIVE: To compare results in terms of orthopaedic complications and quality of life in elderly patients with subtrochanteric fracture treated with intramedullary nailing according to fracture reduction status. PATIENTS AND METHODS: A prospective cohort study including 90 elderly patients with subtrochanteric fractures of the femur treated with a cephalomedullary nail, with a minimum 1-year follow up. The inclusion criteria were: aged 60 years or older, without severe cognitive dysfunction and independent ambulatory capability before the fracture. We defined 3different groups in relation to fracture reduction status: good, acceptable and poor, according to modified criteria from Baumgartner et al. We compared clinical and surgical characteristics and healthy quality of life, social function and mobility according to the EQ-5D, Jensen Index and Mobility Score of Parker and Palmer questionnaires. RESULTS: We found differences in time to union, better in the good reduction group (P=.002); need for open reduction, more frequent in the good reduction group (P<.001), and in postoperative complications, more frequent in the poor reduction group (P=.001). We found no significant differences between the 3groups regarding scores in quality of life, social function and mobility. CONCLUSIONS: Reduction in subtrochanteric fractures in older people is key to obtaining better clinic and surgical results, improving time to union and decreasing surgical complications. Exposure of the focus fracture seems to be a safe manoeuvre. Quality of life had substantially deteriorated n these patients, but a there was a tendency, although not statistically significant, for it to improve in patients after good surgical reduction.

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Introdución. La apertura completa del ligamentum carpi transversum (LCT) es el tratamiento de elección para el síndrome del túnel carpiano. Sin embargo, la pérdida de fuerza de prensión y el dolor sobre la eminencia tenar e hipotenar, denominado «pillar pain» son complicaciones comunes asociadas a dicha técnica. Se han descrito técnicas que reconstruyen dicho ligamento o lo elongan para disminuir estas complicaciones. Objetivo. Analizar la efectividad de la elongación en Z del LCT y la disminución de dichas complicaciones comparándolo con la apertura completa del LCT. Material y método. Se realiza un estudio de intervención prospectivo aleatorizado de 80 pacientes. Los pacientes fueron divididos en 2 grupos: 1) apertura completa de LCT; 2) elongación en Z según técnica modificada de Simonetta. Se analiza la fuerza de agarre, presencia de pillar pain y valoración clínica y funcional mediante el cuestionario Levine. Resultados. No hay diferencias estadísticamente significativas (p>0,05) en la pérdida de fuerza de agarre y presencia de pillar pain entre ambas técnicas en las revisiones realizadas a los 15 días, un mes, 3 meses y un año posquirúrgico. Sí hay diferencias estadísticamente significativas entre los datos preoperatorios y postoperatorios sin embargo, no hay diferencias estadísticamente significativas en el cuestionario de Levine entre ambas técnicas. Discusión. La elongación en Z del LCT es una técnica igual de efectiva que la apertura completa para el tratamiento del síndrome del túnel carpiano pero sin ofrecer ventajas en cuanto a la disminución de fuerza, presencia de pillar pain o mejoría de los resultados funcionales (AU)

Background. Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and 'pillar pain', are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. Objective. The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. Methods. A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. Results. No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. Discussion. In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications (AU)

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Introducción. Actualmente, para disminuir el sangrado postoperatorio en la cirugía de artroplastia de cadera y rodilla, hay suficiente evidencia científica para recomendar el uso del ácido tranexámico (ATX), sin embargo, la dosis y pauta ideal para obtener su máximo beneficio es desconocida. Objetivo. Analizar la efectividad y seguridad del uso del ATX en cirugía de artroplastia de cadera y rodilla a dosis fijas de 2 gramos (g) intravenosos con dos pautas diferentes. Material y métodos. Se realiza un estudio de intervención prospectivo aleatorizado de 240 pacientes. Los pacientes fueron divididos en 3 grupos: 1) control; 2) administración de 1g de ATX intraoperatorio y otro postoperatorio; 3): 2g de ATX preoperatorios. Cada grupo consta de 40 pacientes intervenidos de artroplastia total de rodilla y otros 40 de cadera. Se estudia la pérdida sanguínea postoperatoria, índice de transfusiones y la aparición de complicaciones tromboembólicas. Resultados. Se obtienen diferencias estadísticamente significativas (p<0,05) en la pérdida sanguínea y transfusión entre grupo 1 y grupos 2 y 3, pero no entre grupos 2 y 3. Observamos una complicación en grupo 1 (trombosis venosa profunda). Discusión. Se realizó este estudio no para confirmar la eficacia del ATX, un hecho ya establecido, si no para confirmar si la pauta empírica de 2 g iv. es segura y qué pauta es más beneficiosa. En conclusión podemos decir, coincidiendo con la literatura, que ambas pautas probadas de ATX son efectivas en la reducción de pérdida sanguínea y en las necesidades de transfusión sin aumentar el índice de complicaciones (AU)

Background. There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown. Objective. Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes. Material and methods. A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied. Results. There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis). Discusion. This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate (AU)

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BACKGROUND: Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and "pillar pain", are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. OBJECTIVE: The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. METHODS: A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. RESULTS: No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. DISCUSSION: In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications.

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BACKGROUND: There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown. OBJECTIVE: Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes. MATERIAL AND METHODS: A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: 1) control; 2) 1g of TXA intraoperative, followed by another postoperative; and 3): 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty. Postoperative blood loss, transfusion rate, and thromboembolic complications were studied. RESULTS: There were significant differences (p<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis). DISCUSION: This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen. In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.

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