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Introducción: El dolor crónico es una de las causas más frecuentes de consulta médica en el mundo, las de causa osteomioarticular son las más frecuentes. Esto genera un gran consumo de medicamentos, muchos de los cuales producen efectos adversos que comprometen la calidad de vida de los pacientes. Objetivos: Obtener información sobre la efectividad de la ozonoterapia en el dolor crónico osteoarticular. Método: Se realizó una revisión bibliográfica de los artículos publicados en los últimos 15 años sobre esta temática. A través del buscador Google Académico, se revisaron documentos de carácter académico como artículos, tesis, libros, patentes, documentos relativos a congresos y resúmenes de diferentes bases de datos, como son Web of Science, MEDLINE, SciELO, pubmed, todas ellas ajustadas al ámbito biomédico. En primer lugar, se realizó una búsqueda general, y en función de lo que se vio que era más relevante con respecto al tema, se realizaron posteriormente nuevas búsquedas con términos más concretos, en los idiomas español e inglés. No se aplicó ninguna restricción de ámbito geográfico, edad, ni campo de investigación. Se encontraron 750 resultados iniciales, de los cuales se seleccionaron un total de 36. Conclusiones: Se concluye que hay artículos sobre la ozonoterapia, que respaldan su uso como una herramienta terapéutica efectiva y económica en el tratamiento del dolor crónico osteomioarticular, con mayor evidencia en el tratamiento del dolor por enfermedades del disco intervertebral

La reconstrucción radio distal tras la resección de tumores en esa localización, constituye un desafío para el cirujano ortopédico. Hemos modificado la técnica de reconstrucción utilizando el aloinjerto osteoarticular de radio distal contralateral y presentamos nuestra experiencia. El objetivo principal de esta modificación es evitar la inestabilidad estructural del aloinjerto de radio y mejorar su función. Estabilizamos el aloinjerto contralateral mediante una placa y tornillos sobre la superficie volar del radio. El complejo fibrocartilago triangular y los ligamentos palmares de la muñeca se suturan a los ligamentos correspondientes del aloinjerto. La articulación de la muñeca se fija con agujas de Kirschner durante 6 semanas. Se evaluaron cuatro pacientes con aloinjerto osteoarticular de radio distal contralateral con una edad media de 28 años (rango de 23 a 33) y con una media de seguimiento de 42 meses. Obtuvimos ausencia de recidivas locales y una correcta consolidación del aloinjerto en todos los casos. El rango de movilidad articular medio fue 36,3° flexión dorsal, 17,5° flexión volar, 10,7° abducción, 10° aducción, 62,5° pronación y 46,3° de supinación. La reconstrucción del radio distal con aloinjerto contralateral es una técnica útil para solucionar grandes defectos osteoarticulares y provee mayor estabilidad articular al cambiar la orientación de la carilla articular del radio., The reconstruction of the distal radius after excision of a skeletal tumor in this location is a challenge for the orthopedic surgeon. The objective of our modification is to prevent structural instability in the allograft and improve its function. We report our experience with the use of a contralateral osteoarticular allograft. The allograft was stabilized with a plate and screws above the volar surface of the radius. The palmar ligaments of the wrist and the fibrocartilage complex were sutured to the corresponding ligaments of the allograft. The wrist joint was fixed with a Kirschner wire for six weeks. We report 4 patients with a contralateral osteoar- ticular allograft. The average age was 28 years (range 23 to 33) and the average follow-up was 42 months. The average range of wrist motion was: dorsal flexion 36.3°; volar flexion 17.5°; abduction 10.7°; adduction 10°; supination 46.3° and pronation 62.5°. Correct union of the allografts and absence of local recurrence of the tumor was obtained in all patients. The reconstruction of the distal radius with a contralateral osteoarticular allograft is a useful technique for repairing large defects and greater joint stability is achieved by changing direction of the articular surface of the radius.

Tuberculosis of the wrist region is unusual site and requires high index of suspicion to get a validated diagnosis. The pattern of clinical features and their vagueness contribute to its neglect or misdiagnosis . Various other chronic pain disorders of the wrist can mimic the tubercular affectation of the wrist and vice versa. Complex regional pain syndrome type 1 is the clinical entity that can closely resemble prodromal features of tubercular disease especially in the settings of history of minor trauma and history of consequent immobilization as its treatment.

Background: After a tumor resection, the reestablishment of the bone continuity at the forearm remains a challenge for restoring the biomechanics of hand and elbow. Bone allograft might be one option to consider amongst other suitable alternatives but there are insufficient data available to substantiate its value. Patients and methods: We retrospectively investigated a series of ten consecutive patients that had presented a bone tumour at the forearm. After bone excision, the segmental loss was replaced either by a bone allograft or an osteochondral allograft. Patients were reviewed clinically and with radiographs. Results: The mean follow-up was 110 ± 99 months. Fracture of the allograft was the most prevalent complication occurring in four patients, mainly in the osteoarticular group. Four patients were surgically revised: two of them had a fracture of the allograft that required a new one, another one had a painful stiff wrist requiring removal of the allograft and arthrodesis with autograft and the fourth one had a non-union of an intercalary allograft that was treated by a distal ulnar joint resection. Intercalary allograft had fewer complications than osteoarticular allografts and they had a better functional MSTS score with an average of 79% of a normal function compared to osteoarticular allografts with an average score of 62%. There was no infection. At the latest follow-up, one reconstruction of the forearm with an allograft failed and concerned the distal radius joint. Discussion: A bone allograft when available can be considered as one amongst other suitable options for the reconstruction of the forearm skeleton. Level of evidence: Level IV, retrospective series. © 2011 Elsevier Masson SAS.

Background: After a tumor resection, the reestablishment of the bone continuity at the forearm remains a challenge for restoring the biomechanics of hand and elbow. Bone allograft might be one option to consider amongst other suitable alternatives but there are insufficient data available to substantiate its value. Patients and methods: We retrospectively investigated a series of ten consecutive patients that had presented a bone tumour at the forearm. After bone excision, the segmental loss was replaced either by a bone allograft or an osteochondral allograft. Patients were reviewed clinically and with radiographs. Results: The mean follow-up was 110 ± 99 months. Fracture of the allograft was the most prevalent complication occurring in four patients, mainly in the osteoarticular group. Four patients were surgically revised: two of them had a fracture of the allograft that required a new one, another one had a painful stiff wrist requiring removal of the allograft and arthrodesis with autograft and the fourth one had a non-union of an intercalary allograft that was treated by a distal ulnar joint resection. Intercalary allograft had fewer complications than osteoarticular allografts and they had a better functional MSTS score with an average of 79% of a normal function compared to osteoarticular allografts with an average score of 62%. There was no infection. At the latest follow-up, one reconstruction of the forearm with an allograft failed and concerned the distal radius joint. Discussion: A bone allograft when available can be considered as one amongst other suitable options for the reconstruction of the forearm skeleton. Level of evidence: Level IV, retrospective series. © 2011 Elsevier Masson SAS.

A 54 year old male who had an unusual clinical manifestation and radiological features proven to have tuberculosis arthritis of the knee on synovial biopsy is presented here.

The two types of clinical presentation of tuberculosis (TB) are pulmonary, which is the most frequent, and extrapulmonary. Although TB prevalence has been coming down, extrapulmonary TB numbers remain stable; with approximately 1'050.000 new cases reporte

Los dos tipos de manifestación clínica de la tuberculosis (TB) son la pulmonar y la extrapulmonar, de las cuales la primera es la más frecuente. No obstante, si bien se ha logrado disminuir la prevalencia de la TB en general, las cifras de TB extrapulmonar se mantienen estables; se notificaron aproximadamente 1’050.000 casos nuevos en el mundo en 2018. Por lo general, se presenta por diseminación hematógena o linfática del bacilo del complejo Mycobacterium tuberculosis a otros órganos. Los sitios afectados más frecuentes son pleural, ganglionar, tubo digestivo y osteoarticular. Otros menos habituales son el sistema nervioso central, las vías genitourinarias, las vías aéreas superiores, el pericardio y la piel. Las manifestaciones clínicas de la TB extrapulmonar son variables por su naturaleza paucibacilar y constituye un verdadero reto para los clínicos. La aproximación diagnóstica depende del sitio de afectación, la facilidad de toma de la muestra, la sensibilidad de las pruebas y la distribución de la micobacteria en el tejido. La enfermedad usualmente responde al tratamiento estándar para TB y el tiempo ideal del régimen varía según el sitio afectado. El propósito de esta revisión es describir la presentación clínica y el proceso diagnóstico de la TB extrapulmonar.