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One of the risks of distraction osteogenesis-based techniques is the development of vascular complications, such as pseudoaneurysms associated with the osteotomies performed or the fixation elements of the external fixator used in the procedure.Pseudoaneurysm are formed when the tunica adventitia of the artery is injured, resulting in a gradual and persistent blood extravasation into the surrounding tissues that is encapsulated and connected to the arterial lumen.This report describes a rare case of a late-presentation pseudoaneurysm in the anterior tibial artery resulting from a tibial lengthening procedure aimed at addressing a leg length discrepancy in a 57-year-old female with severe peripheral neuropathy resulting from long-standing poorly controlled diabetes mellitus. We describe the diagnostic process, the treatment options and confirm how the shape of the bony callus can be a reliable indicator of this pathology, as has already been described in the literature.

Resumen: Introducción: La aplicación informática SCAE-SM (Solicitud de Cita en Atención Especializada-Sospecha de Malignidad) es una herramienta informática de la que disponen los médicos de Atención Primaria (AP) para la derivación de pacientes que deban ser valorados por el especialista en un plazo máximo de 2 semanas, cuando se sospeche una patología maligna. El objetivo de nuestro trabajo fue analizar la utilidad de esta herramienta y proponer áreas de mejora en la gestión de los pacientes con sospecha de malignidad musculoesquelética. Material y métodos: Se realizó un estudio descriptivo transversal de las 235 derivaciones recibidas en los años 2012-2017. Se analizó su procedencia, la información contenida en las solicitudes y la respuesta proporcionada por evaluadores históricos (facultativos traumatólogos sin formación específica oncológica). Para este estudio, se ha realizado una nueva valoración ciega de todas las solicitudes por 13 traumatólogos con distinto nivel de formación específica en oncología musculoesquelética (reevaluadores). Resultados: De entre todas las SCAE-SM, solo el 8,23% de los pacientes presentaron enfermedad maligna o benigna agresiva. Los reevaluadores más acertados en la adecuación del adelanto de cita fueron aquellos con formación oncológica moderada (5-10 años de experiencia). Durante el periodo de tiempo del estudio, de todos los pacientes tratados en la Unidad de Tumores, solo el 18,81% accedieron por el circuito SCAE-SM, transcurriendo un tiempo medio de espera de 18,11 días desde la derivación de AP. Conclusiones: La aplicación informática SCAE-SM como herramienta de gestión y adelanto de la asistencia a los pacientes con patología tumoral musculoesquelética maligna es útil, si bien el uso del circuito es inadecuado. Es necesario difundirlo y generalizarlo, así como implementar programas de formación oncológica básica tanto en el ámbito de la AP como de la Hospitalaria. Abstract: Introduction: The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care (PC) physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. Material and methods: A descriptive cross-sectional study of 235 referrals received in the years 2012–2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). Results: Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5–10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. Conclusions: The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of PC and Hospital.

Abstract Background The use of 18F-FDG Positron emission tomography/Computed tomography (PET/CT) in the initial staging of many cancers is clearly established. Most soft tissue sarcoma (STS) has a high affinity for 18F-FDG, which is why 18F-FDG PET/CT has been proposed as a non-invasive method, useful in diagnosis and follow-up. The standardized uptake value values (SUV), the volume-based metabolic parameters MTV (metabolic tumor volume), and TLG (total lesion glycolysis) determine tumor viability and provide its total volume and the total activity of metabolically active tumor cells. The histological grade is the most important predictor of metastases and mortality associated with STS, and a significant relationship between the metabolic parameters of 18F-FDG PET/CT and the histological grade has been described. Methods A retrospective study was conducted on STS patients, who had histological grade according to the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) criteria, as well as a baseline PET/CT. SUV (SUVmax, SUVmean, and SUVpeak), MTV, and TLG were quantified. A T-student test was performed to establish the relationship between the metabolic biomarkers and the histological grade. Their usefulness as predictors of the histological grade was verified using receiver operator characteristic (ROC) curves. A survival function study was performed using the Kaplan–Meier method. To assess the prognostic utility of the metabolic biomarkers we use the Log-Rank method. Results The SUV values were useful to discriminate high-grade STS. We found a significant relationship between the histological grade and the SUV values. SUVmax, SUVpeak, MTV, and TLG were predictors of overall survival (OS). There were no significant differences in the OS for the SUVmean, or in the disease-free survival (DFS) for SUVmax, SUVmean, SUVpeak, MTV, and TLG. Conclusions The SUVmax, SUVmean, and SUVpeak values correlate with the HG and are useful to discriminate high-grade from low-grade STS. Patients with high SUVmax, SUVpeak, MTV, and TLG have a significantly lower OS.

Introduction: The SCAE-SM (Request for an Appointment in Specialized Care-Suspicion of Malignancy) computer application is a tool available to Primary Care physicians for the referral of patients who should be evaluated by the specialist in a maximum period of 2 weeks when malignancy is suspected. The objective of our work was to analyze the usefulness of this tool and propose areas for improvement in the management of patients with suspected musculoskeletal malignancy. Material and methods: A descriptive cross-sectional study of 235 referrals received in the years 2012–2017 was carried out. Their origin, the information contained in the applications and the response provided by historical evaluators, without specific oncology training, were analyzed. For this study, a new blind assessment of all applications was carried out by 13 orthopedists with different levels of specific training in musculoskeletal oncology (re-evaluators). Results: Among all SCAE-SM, only 8.23% of patients had aggressive benign or malignant disease. The most successful re-evaluators in the adequacy of early appointment were those with moderate oncological training (5–10 years of experience). During the study, of all the patients treated in the Tumor Unit, only 18.81% accessed through the SCAE-SM circuit, with a mean waiting time of 18.11 days from the PC referral. Conclusions: The SCAE-SM computer application as tool for improve the management and advance care for patients with malignant musculoskeletal tumor pathology is useful, although the use of the circuit is inadequate. It is necessary to disseminate and generalize it, as well as to implement basic oncology training programs both in the field of Primary Care and Hospital. Resumen: Introducción: La aplicación informática Solicitud de Cita en Atención Especializada-Sospecha de Malignidad (SCAE-SM) es una herramienta informática de la que disponen los médicos de atención primaria (AP) para la derivación de pacientes que deban ser valorados por el especialista en un plazo máximo de 2 semanas, cuando se sospeche de una enfermedad maligna. El objetivo de nuestro trabajo fue analizar la utilidad de esta herramienta, y proponer áreas de mejora en la gestión de los pacientes con sospecha de malignidad musculoesquelética. Material y métodos: Se realizó un estudio descriptivo transversal de las 235 derivaciones recibidas en los años 2012-2017. Se analizó su procedencia, la información contenida en las solicitudes y la respuesta proporcionada por evaluadores históricos (facultativos traumatólogos sin formación específica oncológica). Para este estudio se ha realizado una nueva valoración ciega de todas las solicitudes por 13 traumatólogos con distinto nivel de formación específica en oncología musculoesquelética (re-evaluadores). Resultados: De entre todas las SCAE-SM, solo el 8,23% de los pacientes presentaron enfermedad maligna o benigna agresiva. Los re-evaluadores más acertados en la adecuación del adelanto de cita fueron aquellos con formación oncológica moderada (5-10 años de experiencia). Durante el periodo de tiempo del estudio, de todos los pacientes tratados en la unidad de tumores, solo el 18,81% accedieron por el circuito SCAE-SM, transcurriendo un tiempo medio de espera de 18,11 días desde la derivación de AP. Conclusiones: La aplicación informática SCAE-SM como herramienta de gestión y adelanto de la asistencia a los pacientes con enfermedad tumoral musculoesquelética maligna es útil, si bien el uso del circuito es inadecuado. Es necesario difundirlo y generalizarlo, así como implementar programas de formación oncológica básica tanto en el ámbito de la AP como de la hospitalaria.

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Since late 1992 we started performing posterior lumbar interbody fusions together with pedicular screws and intertransverse fusion. Later on we decided to use posterior lumbar interbody fusions with titanium cages and autologous bone. We are presenting our results with a group of 52 patients with 6 months to 4 and a half years of follow-up. We have used the Prolo Functional Economic Outcome Rating Scale to evaluate our results, obtaining a high percentage (92%) of satisfactory results. The fusion's percentage was also very high, although we express the difficulty to evaluate the fusion grade considering the X-ray artifact produced by the cages. We conclude that PLIF with cages it is a surgical procedure with a high rate of success if we establish clearly the clinical criteria for its application and perform correctly the surgical technique.