Papers by Enrique Guerado
Acoustics, Speech, and Signal Processing Newsletter, IEEE
![Research paper thumbnail of [Bankart repair. Comparative study with and without suction drainage to assess shoulder pain and functional limitation]](https://a.academia-assets.com/images/blank-paper.jpg)
The purpose of this study is to compare two patient cohorts with Bankart lesion, one with intraar... more The purpose of this study is to compare two patient cohorts with Bankart lesion, one with intraarticular drainage after surgery and another group without drainage. We designed a study cohort for patients with Bankart repair due to relapsing shoulder dislocation; they underwent arthroscopy and were stabilized with suture anchors; intraarticular drainage was used in one group and no drainage was used in a control patient cohort. Thirty-one consecutive patients were operated by the same team. All patients were evaluated at the office using the Rowe, Constant and UCLA scales. The statistical tests used included chi-square, the student-t test or the Wilcoxon rank sum test (nonparametric version). The UCLA median value was 35 (34.5-35) in group B and 33 (32.5 -35) in group A, with p = 0.13. The Rowe test score was 100 (95;100) in group B and 100 in group A (85;100), with p = 0.913. The Constant test score was 96 (88.8-98) in group B and 96 (90.5-100) in group A with p = 0.535 and no differences. This comparative study includes two groups that underwent arthroscopic Bankart repair, one with drainage and another one without drainage. Good results were obtained in both groups. In this study the placement of a postoperative intraarticular drainage did not improve clinical results, as no statistically significant differences were observed between both groups.
The Bone & Joint Journal
We studied 16 patients suffering from osteoarthritis of the hip who had had Perthes' dise... more We studied 16 patients suffering from osteoarthritis of the hip who had had Perthes' disease during childhood. They were compared clinically and radiologically with a control group who had not had Perthes' disease, in order to assess whether a generalised, pre-existing constitutional disorder was present. Nine patients with a previous history of Perthes' disease had some other skeletal abnormality, but only three presented with clinical symptoms. Only one patient in the control group was found to have an abnormality but was symptom-free. Our findings provide further evidence that patients with Perthes' disease may have a generalised abnormality related to chondrogenesis which can produce other skeletal anomalies that persist into adult life.
Acta orthopaedica Belgica
The case of an old volar dislocation of the lunate, associated with median nerve neuropathy, is d... more The case of an old volar dislocation of the lunate, associated with median nerve neuropathy, is described in a 37-year-old patient. The treatment took into account the age of the patient and the relative tolerance to the dislocation. We performed a simple excision of the lunate combined with a release of the transverse carpal ligament in order to free the median nerve, together with a tenosynovectomy of flexor digitorum profoundus. Two years after operation, wrist function was virtually complete and the patient was asymptomatic and had resumed his occupation.
Acta orthopaedica Belgica
A study of the distraction callus in the femur of the growing rabbit was performed. Thirty animal... more A study of the distraction callus in the femur of the growing rabbit was performed. Thirty animals separated into 10 groups were used. Distraction between both ends of a femoral osteotomy induced the formation of a connective callus which subsequently ossified. This callus disappeared between the fourth and the eighth week after the lengthening was completed. The osteogenesis model was of a mixed type, intramembranous and endochondral, with a predominance of the former. The bone healing and the initial signs of remodeling in the newly formed bony tissue were seen at the end of the first week of distraction. The original cortex was resorbed during the lengthening and was progressively substituted by a new cortex, whose formation and remodeling was not finished 24 weeks after the completion of the distraction. Experimental conditions could explain some of the findings.
We present the case of a patient who sustained a gunshot wound; the projectile was located in the... more We present the case of a patient who sustained a gunshot wound; the projectile was located in the knee and was arthroscopically removed. A 31 year-old patient sustained a gunshot wound in the right thigh, right hand and left knee. X-rays revealed the presence of a projectile in the knee, thigh and hand. The projectile was arthroscopically removed. Traumas causing articular wounds of the knee are infrequent. Excluding the most frequent causes of articular wounds, a small percentage of them are due to gunshot wounds. There is consensus around arthroscopy as a technique useful to remove articular foreign bodies; it has advantages over open surgery. This procedure minimizes surgical morbidity, reduces the risk of septic arthritis, synovitis, arthropathy or systemic lead toxicity, and it also hastens the patient's functional recovery. Knee arthroscopy allows physicians to provide a definitive treatment of these injuries, explore the joint, diagnose associated injuries and perform deb...
The Open Orthopaedics Journal, 2015
The term &amp... more The term 'severely injured patient' is often synonymous of polytrauma patient, multiply-injured patient or, in some settings, polyfractured patient. Together with brain trauma, copious bleeding is the most severe complication of polytrauma. Consequently hypotension develop. Then, the perfusion of organs may be compromised, with the risk of organ failure. Treatment of chest bleeding after trauma is essential and is mainly addressed via surgical manoeuvres. As in the case of lesions to the pelvis, abdomen or extremities, this approach demonstrates the application of damage control (DC). The introduction of sonography has dramatically changed the diagnosis and prognosis of abdominal bleeding. In stable patients, a contrast CT-scan should be performed before any x-ray projection, because, in an emergency situation, spinal or pelvic fractures be missed by conventional radiological studies. Fractures or dislocation of the pelvis causing enlargement of the pelvic cavity, provoked by an anteroposterior trauma, and in particular cases presenting vertical instability, are the most severe types and require fast stabilisation by closing the pelvic ring diameter to normal dimensions and by stabilising the vertical shear. Controversy still exists about whether angiography or packing should be used as the first choice to address active bleeding after pelvic ring closure. Pelvic angiography plays a significant complementary role to pelvic packing for final haemorrhage control. Apart from pelvic trauma, fracture of the femur is the only fracture provoking acute life-threatening bleeding. If possible, femur fractures should be immobilised immediately, either by external fixation or by a sheet wrap around both extremities.
Cellular and molecular biology (Noisy-le-Grand, France)
Regeneration takes place in the body at a moment or another throughout life. Bone, cartilage, and... more Regeneration takes place in the body at a moment or another throughout life. Bone, cartilage, and tendons (the key components of the structure and articulation in the body) have a limited capacity for self-repair and, after traumatic injury or disease, the regenerative power of adult tissue is often insufficient. When organs or tissues are irreparably damaged, they may be replaced by an artificial device or by a donor organ. However, the number of available donor organs is considerably limited. Generation of tissue-engineered replacement organs by extracting stem cells from the patient, growing them and modifying them in clinical conditions after re-introduction in the body represents an ideal source for corrective treatment. Mesenchymal stem cells (MSCs) are the multipotential progenitors that give rise to skeletal cells, vascular smooth muscle cells, muscle (skeletal and cardiac muscle), adipocytes (fat tissue) and hematopoietic (blood)-supportive stromal cells. MSCs are found in ...
The open orthopaedics journal, 2012
Acetabular fractures in the elderly are increasingly common; however, an antecedent of trauma may... more Acetabular fractures in the elderly are increasingly common; however, an antecedent of trauma may not be known, and the diagnosis easily missed. Early identification and prompt management are needed in order to minimise morbidity rates, but little has been published on occult acetabular fracture.In this paper we present three cases of occult acetabular fracture in patients older than 75 years. All three are females and had previously been operated on the ipsilateral hip with an implant (two proximal femur fractures treated with a proximal intramedullary femoral nail, and one case of total joint replacement); these acetabular fractures could be related to the existence of a stress shielding mechanism.We believe that whenever an elderly patient feels groin pain, and anteroposterior pelvis X-rays are normal, oblique Judet projections (obturator and iliac) should be obtained. In any case, displacement will make any fracture evident within a few weeks.
The open orthopaedics journal, 2013
In recent decades, many technical improvements have been achieved in the use of prosthetic joints... more In recent decades, many technical improvements have been achieved in the use of prosthetic joints, and the risk of infection has been greatly reduced, to current rates of 0.4-2.0% following primary knee replacement. However, the increasing rate of joint replacements being performed means that the absolute number of such infections remains significant and poses substantial costs to healthcare systems worldwide. Accordingly, further strategies to treat and prevent total joint infections should be investigated. Infections following knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and debridement with component retention can be attempted to salvage the implant. This is an attractive, cheap, low-morbidity treatment for periprosthetic knee infection. However, the results published regarding this procedure are uneven; some studies report the eradication of prosthetic joint infecti...
Revista Española de Cirugía Ortopédica y Traumatología, 2004
... entre el 80%-90%2. Con el desarrollo de las técnicas artroscópicas en el hom-bro, Ellman3 en ... more ... entre el 80%-90%2. Con el desarrollo de las técnicas artroscópicas en el hom-bro, Ellman3 en 1985 propuso realizar la descompresión su-bacromial mediante artroscopia, obteniendo resultados simi-lares a la ... Se tomaron datos de filiación, lateralidad y situación la-boral. ...
Thescientificworldjournal, 2007
Recent studies on the morphogenesis of the fins of Danio rerio (zebrafish) during development and... more Recent studies on the morphogenesis of the fins of Danio rerio (zebrafish) during development and regeneration suggest that a number of inductive signals involved in the process are similar to some of those that affect bone and cartilage differentiation in mammals and humans. Akimenko et al. (2002) has shown that bone morphogenetic protein-2b (BMP2b) is involved in the induction of dermal bone differentiation during fin regeneration. Many other groups have also shown that molecules from the transforming growth factor-beta superfamily (TGFb), including BMP2, are effective in promoting chondrogenesis and osteogenesis in vivo in higher vertebrates, including humans. In the present study, we review the state of the art of this topic by a comparative analysis of skeletal tissue development, regeneration and renewal processes in tetrapods, and fin regeneration in fishes. A general conclusion of this study states that lepidotrichia is a special skeletal tissue different to cartilage, bone, enamel, or dentine in fishes, according to its extracellular matrix (ECM) composition. However, the empirical analysis of inducing signals of skeletal tissues in fishes and tetrapods suggests that lepidotrichia is different to any responding features with main skeletal tissues. A number of new inductive molecules are arising from fin development and regeneration studies that might establish an empirical basis for further molecular approaches to mammal skeletal tissues differentiation. Despite the tissue dissimilarity, this empirical evidence might finally lead to clinical applications to skeletal disorders in humans.
Revista Española de Cirugía Ortopédica y Traumatología, 2014
Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents... more Traumatic dislocation of the posterior tibial tendon (PTT) has a very low prevalence. It presents with pain and recurrent snapping on the posterior side of the medial malleolus after an ankle sprain while practicing sports. The diagnosis is based on clinical examination, supported by imaging techniques. The treatment must be always surgical. A 28 year old man sprained ankle his ankle while jogging. He was treated in an emergency department with an elastic bandage. Once he recovered, he went back to running, noticing a projection with ankle pain. In the physical examination the PTT was reproduced with inversion maneuvers and forced dorsiflexion. Ultrasound and MRI were performed on the ankle. The patient was operated on, leaving a stable ankle with no projection. Three months later he had no pain and restarted his physical activities. Surgical treatment of PTT dislocation by re-anchoring the flexor retinacula provides an excellent functional outcome.
Hip International, 2010
Complex acetabular fractures are best treated by a surgical approach. Although some other variabl... more Complex acetabular fractures are best treated by a surgical approach. Although some other variables such as comminution or cartilage lesion of the femoral head are related to the final outcome, early anatomic reduction is the only way to get good results; this has made the appropriate type of surgical approach of overwhelming importance. Seeing the fracture and also having the possibility of manoeuvring its fragments as much as required are the keys for reduction of these sort of fractures. In this paper we have studied the results of the treatment of complex acetabular fractures by simultaneous ilioinguinal and Kocher-Langenbeck approaches. Ten cases of complex fractures out of 260 surgically treated acetabular fractures were chosen for simultaneous combined approaches. In cases of comminution of both the anterior and the posterior columns together with circumferential shortening of the pelvic ring, reduction and stable internal fixation could be accomplished only by simultaneous combined accesses.
Revista Española de Cirugía Ortopédica y Traumatología, 2014
Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment ... more Thoracolumbar spine fractures are frequent and severe. Early diagnosis and appropriate treatment to obtain good clinical results is essential, with many classifications being proposed for this purpose. To determine the external validity of radiographic and computed tomography (CT) measurements for the most used classifications, and decide on the type of treatment required. The working hypothesis is the existence of external validity of radiographic measurements. A sample of patients with thoracolumbar fracture was selected. Three spine specialists and a resident performed measurements on anteroposterior and lateral radiographic images as well as coronal, sagittal and axial CT slices. Fractures were classified as stable or unstable, evaluating the degree of intra-and interobserver agreement based on a standard observer. Sagittal index of Farcy, lateral wedging, Beck Index, traumatic regional angulation and channel occupancy were studied. All indicators studied, except the lateral wedging, showed a high degree of concordance. Instability determinants studied with radiographs and CT, which had obtained statistical significance, are reliable and accurate for the classification of thoracolumbar fractures and, therefore, to indicate an appropriate treatment.
Revista Española de Cirugía Ortopédica y Traumatología, 2003
ABSTRACT
Objectives The purpose of this study was to analyze functional and radiologic results of a consec... more Objectives The purpose of this study was to analyze functional and radiologic results of a consecutive series of elderly patients who underwent uncemented hemiarthroplasty as primary treatment of complex proximal humeral fractures. Methods Twenty-one patients with severe proximal humerus fracture (three or four fragments and three-or four-fragment fracture dislocations) were treated with uncemented proximal humerus hemiarthroplasty. Patients were evaluated using the Constant-Murley Score, the Quick scale Disabilities of Arm, Shoulder and Hand (Quick-DASH) Score, range of motion, residual pain, radiographic parameters, and complications including clinical and radiologic data of mobilization.
To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruct... more To study postoperative complications of arthroscopic anterior cruciate ligament (ACL) reconstruction performed as an outpatient compared with same surgery performed as a regular admission (inpatient). A study was conducted on a historical cohort of 342 patients (115 outpatients vs 227 inpatients) who underwent arthroscopic ACL primary ligamentoplasty (2004-2012). A review was performed on the demographic, surgical and hospital variables. A study was made of early complications (60 days postoperative) including visits to emergency department and readmissions. A descriptive and bivariate distribution analysis was performed between groups, with the grouping criterion: performing of the surgery with or without admission. The Chi-square test was used for qualitative variables and Mann-Whitney U test for quantitative. Limit significance p<0.05. Overall, there were 13.2% emergency department visits (mean of 1.24 visits) with an average delay of 8.22 days after discharge. Complications: pain not controlled with analgesia (6.7%), hemarthrosis that required arthrocentesis (4.4%), fever (3.2%), deep vein thrombosis (0.6%), cellulitis (0.6%), septic arthritis that required arthroscopic debridement (0.3%), and others (1.2%) including problems with immobilization. The hospital readmissions (2.3%) were for surveillance and monitoring of the surgical wound. In the bivariate analysis no statistically significant differences were found between groups as regards the sociodemographic characteristics of the patients or the complications recorded. The most frequent complications recorded were acute pain, hemarthrosis and fever. Serious complications (deep vein thrombosis, septic arthritis or need for hospital readmission) were rare. Outpatient arthroscopic ACL repair is a common technique that can be performed safely by surgery without admission, with an overall low complication rate with no differences between outpatients and inpatients.
Uploads
Papers by Enrique Guerado