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Objectives: This study presents our experience in surgical treatment of extravertebral bone hydatidosis and aims to investigate the utility of specific immunoglobulin E (IgE) in diagnosis and prognosis of the disease. Patients and methods: Between January 1990 and December 2019, a total of 10 patients (6 males, 4 females; mean age: 47.2±14.7 years; range, 27 to 71 years) with non-vertebral bone hydatidosis surgically treated in our hospital were retrospectively included. Curettage or wide resection was performed in all cases, followed by medical antihelminthic therapy. Specific IgE p2 was studied in seven patients during and at final follow-up. Results: At the time of diagnosis, secondary infection of the cyst was observed as the initial symptom in two patients mimicking an abscess and, in both cases, more surgeries were required without final healing. In two cases, over five specific IgE presented a false negative at the time of diagnosis and it was not correlated with clinical evolution in three cases over seven. In six cases, diagnosis was obtained before surgery. In treatment, pelvic disease had the worst prognosis (none healed) and bacterial overinfection was a common complication after surgery. At the final follow-up, only two femoral cases (20%) were free of disease. Other four cases (three in iliac bone, one in proximal femur) needed several surgeries without healing. The other four patients showed no progression or refused a new surgical treatment. Conclusion: Location, bone defect, when it is possible to perform a radical surgery, and associated bacterial overinfection after surgery make cystic hydatidosis in bone an infection very difficult to treat definitively in humans. Negative specific IgE does not exclude bone hydatidosis.

Objectives: This study aims to assess the development of osteoarthritis (OA) in granzyme A- (gzmA) and B- (gzmB) and perforin- (perf) knockout mice. Materials and methods: A total of 75 male and female C57BL/6 (eight to nine-week-old) mice were allocated to: gzmA-deficient (gzmA-/-) (11 females, 8 males), gzmB-deficient (gzmB-/-) (9 females, 8 males), perf-deficient (perf-/-) (10 females, 9 males), and control group (10 females, 10 males). Osteoarthritis was induced in the right knee by instability of the meniscus medial ligament. Sham surgery was practiced in the left knee. Knee samples obtained eight weeks after surgery were stained (Safranin-O) and blindly scored in lateral and medial femur and tibia using the Osteoarthritis Research Society International scale (OARSI) (from Grade 0, cartilage intact to 6, deformation), (five stages from 0, no OA to 4, >50% surface involvement); OARSI score (grade x stage); and a semi-quantitative scale from Grade 0 (normal) to 6 (cartilage erosion >80%). Results: Significantly higher values in all scales in the right knees compared to the left knees in male and female mice were observed (p

This paper presents a decision support system to be used in hospital management taskswhich is based on the clinical pathways. We propose a very simple graphical modeling lan-guage based on a small number of primitive elements through which the medical doctorscould introduce a clinical pathway for a specific disease. Three essential aspects relatedto a clinical pathway can be specified in this language: (1) patient flow; (2) resource uti-lization; and (3) information interchange. This high-level language is a domain specificmodeling language calledHealthcare System Specification (HSS), and it is defined as anUnified Modeling Language (UML) profile. A model to model transformation is also pro-posed in order to obtain, from the pathways HSS specification, a Stochastic Well-formedNet (SWN) model that enables a formal analysis of the modeled system and, if needed, toapply synthesis methods enforcing specified requirements. The transformation is based onthe application of local rules. The clinical pathway of hip fracture from the “Lozano Blesa”University hospital in Zaragoza is taken as an example.

The incidence of bone fracture has become a major clinical problem on a worldwide scale. In the past two decades there has been an increase in the use of computational tools to analyse the bone fracture problem. In several works, various study cases have been analysed to compare human and animal bone fracture healing. Unfortunately, there are not many publications about computational advances in this field and the existing approaches to the problem are usually similar. In this context, the objective of this work is the application of a diffusion problem in the model of the bone fragments resulting from fracture, working together with a mesh-growing algorithm that allows free growth of the callus depending on the established conditions, without a pre-meshed domain. The diffusion problem concerns the different biological magnitudes controlling the callus growth, among which Mesenchymal Stem Cells and chondrocytes concentrations were chosen, together with Tumour Necrosis Factor α and Bone Morphogenetic Protein as the factors influencing the velocity in the callus formation. A Finite Element approach was used to solve the corresponding diffusion problems, obtaining the concentration values along the entire domain and allowing detecting the zones in which biological magnitudes reach the necessary thresholds for callus growth. The callus growth is guided by a geometrical algorithm which performs an additional mesh generation process (self-added mesh) at each step of the iterative procedure until complete callus formation. The proposed approach was applied to different types of diaphyseal femoral fractures treated by means of intramedullary nailing. Axisymmetric models based on triangular quadratic elements were used, obtaining results in good agreement with clinical evidence of these kinds of fractures. The algorithm proposed has the advantage of a natural callus growth, without the existence of a previous mesh that may affect the conditions and direction of growth. The approach is intended for the initial phase of callus growth. Future work will address the implementation of the corresponding formulations for tissue transformation and bone remodelling in order to achieve complete fracture healing.

The objective is to establish the duration of our interventions, intermediate times and surgical performance. This will create a virtual waiting list to apply a mathematical programme that performs programming with maximum performance. Material and methods Retrospective review of 49 surgical sessions obtaining the delay in start time, intermediate time and surgical performance. Retrospective review of 4045 interventions performed in the last 3 years to obtain the average duration of each type of surgery. Creation of a virtual waiting list of 700 patients in order to perform virtual programming through the MIQCP-P until achieving optimal performance. Results Our surgical performance with manual programming was 75.9%, ending 22.4% later than 3 pm. The performance in the days without suspensions was 78.4%. The delay at start time was 9.7 min. The optimum performance was 77.5% with a confidence of finishing before 15 h of 80.6%. The waiting list has been scheduled in 254 sessions. Discussion Our manual surgical performance without suspensions (78.4%) was superior to the optimal (77.5%), generating days finished later than 3 pm and suspensions. The possibilities for improvement are to achieve punctuality at the start time and adjust the schedule to the ideal performance. The virtual programming has allowed us to obtain our ideal performance and to establish the number of operating rooms necessary to solve the waiting list created. Conclusions The data obtained in virtual mathematical programming are reliable enough to implement this model with guarantees.

Supracondylar femoral fractures account for a noticeable percentage of the femoral shaft fractures, affecting two etiological groups: high energy trauma in young men, with good bone quality, and older women with osteoporotic femur. Surgical treatment of those kind of fractures remains controversial, with different surgical options such as plate and sliding barrel locking condylar plate, less invasive stabilization system (LISS) or intramedullary nailing, which has emerged as a new fixation choice in the treatment of that type of fractures. The present work performs a comparative study about the biomechanical behavior of anterograde and retrograde nailing in supracondylar femoral fractures type A, in order to determine the best choice of nailing and locking configuration. A three-dimensional finite element model of the femur was developed, modeling femoral supracondylar fracture and different nailing configurations, both for anterograde and retrograde nails. The study was focused on the immediately post-operative stage, verifying the appropriate stability of the osteosynthesis. The obtained results show a better biomechanical behavior for anterograde nails, providing a better stability from the point of view of global movements, lower stresses in screws, and less stress concentration in cortical bone. So, for the analyzed fractures and osteosyntheses types, anterograde nailing has demonstrated to be a better surgical option, being an excellent indication in supracondylar fractures of femur, with clear benefits compared to retrograde nailing, providing a better stabilization which enables for a more satisfactory fracture healing.

The operation room (OR) is one of the most expensive material resources in hospitals. Additionally, the demand for surgical service is increasing due to the aging population, while the number of surgical interventions performed is stagnated because of budget reasons. In this context, the importance of improving the efficiency of the surgical service is accentuated. The main objective of this work is to propose and to evaluate a Decision Support System (DSS) for helping medical staff in the automatic scheduling of elective patients, improving the efficiency of medical teams&rsquo, work. First, the scheduling criteria are fixed and then the scheduling problem of elective patients is approached by a mathematical programming model. A heuristic algorithm is proposed and included in the DSS. Moreover, other different features are implemented in a software tool with a friendly user interface, called CIPLAN. Considering realistic data, a simulation comparison of the scheduling obtained using the approach presented in this paper and other similar approaches in the bibliography is shown and analyzed. On the other hand, a case study considering real data provided by the Orthopedic Surgical Department (OSD) of the &ldquo, Lozano Blesa&rdquo, hospital in Zaragoza (HCU) is proposed. The simulation results show that the approach presented here obtains similar occupation rates and similar confidence levels of not exceeding the available time than approaches in the bibliography. However, from the point of view of respecting the order of the patients in the waiting list, the approach in this paper obtains scheduling much more ordered. In the case of the Orthopedic Surgical Department of the &ldquo, hospital in Zaragoza, the occupation rate may be increased by 2.83%, which represents a saving of 110,000 euros per year. Moreover, medical doctors (who use this tool) consider CIPLAN as an intuitive, rapid and efficient software solution that can make easier the corresponding task.

Resumen Objetivo Estudiar las causas de produccion y resultados en los pacientes tratados con fractura interprotesica femoral. Material y metodos Revision retrospectiva de 7 pacientes tratados entre 2010 y 2013. Las artroplastias de rodilla tenian al menos 5 anos desde su implantacion y las de cadera menos de un ano siendo cementadas bipolares en 6 pacientes y total no cementada en un paciente, implantadas todas por una fractura desplazada del cuello femoral. Han sido tratadas mediante osteosintesis con placa de estabilidad angular abarcando todo el segmento femoral interprotesico. Excepto un paciente, los demas han sido revisados 12 meses como minimo. Resultados Han sido 6 mujeres y un hombre con edad media de 84,7 anos. La fractura, siempre por baja energia, se ha producido entre 2 y 8 meses tras la de cadera sin encontrarse movilizados los implantes, estando localizadas 4 de ellas a nivel diafisario y 3 a nivel supracondileo, sin relacion con el tipo de implante de rodilla. Se ha producido la consolidacion en todos los pacientes a los 4,5 meses de media sin reintervencion en ninguno de ellos y sin mortalidad en el tiempo que han sido controlados. Todos los pacientes deambulaban en carga en el momento de producirse la fractura y todos ellos han conseguido volver a deambular en carga, habiendo perdido como media 20° de flexion de rodilla en los casos de fractura supracondilea. Conclusiones Los factores mas importantes en nuestros pacientes con respecto a la produccion de la fractura han sido la alteracion de la capacidad de deambulacion tras la artroplastia de cadera y la fragilidad osea. La placa de estabilidad angular concede buenos resultados en el tratamiento de las fracturas interprotesicas femorales.

Intramedullary nailing (IM) is a technique universally accepted to treat femoral diaphyseal fractures. The treatment of fractures located in the distal third remains a controversial issue though. A finite element model of the femur has been developed, analyzing distal fractures with several gap sizes combined with different interlocking combinations of distal screws with one oblique screw proximally to stabilize the intramedullary nail. The mechanical strength of the nail against bending and compression efforts was also studied. Beside the FE simulations, a clinical follow-up of 15 patients, 6 males and 9 females, with mean age of 53.2 years was carried out. Localizations of fractures were 10 in the right femur and 5 in the left femur, respectively. A fairly good correspondence agreement between clinical results and the simulated fractures in terms of gap size was found. Non-comminuted fractures had a mean consolidation time of 20.5 weeks (4.8 months), a tendency corresponding well to the mobility obtained in the FE simulations; Comminuted fractures on the other hand exhibited a higher mean consolidation period of 22.2 weeks (5.2 months) secondary to the excessive mobility at fracture site obtained by means of FE simulations. The best stability at fracture site was found for the system with three distal screws and the system with two distal screws placed medial lateral. The highest leverage of distal screws was obtained maximizing the distance between them and choosing the coronal plane for their orientation. The results obtained with both nail materials (stainless steel and titanium alloy) show a higher mobility when using titanium nails. Steel nails provide stiffer osteosyntheses than the titanium nails. In conclusion, the best screw combination in terms of stability to produce fracture healing and the least difficulties during treatment is the one which had one oblique proximal screw with two distal lateral screw implanted in the coronal plane.

Mesenchymal stem cells (MSCs) are gaining relevance for treating equine joint injuries because of their ability to limit inflammation and stimulate regeneration. Because inflammation activates MSC immunoregulatory function, proinflammatory priming could improve MSC efficacy. However, inflammatory molecules present in synovial fluid or added to the culture medium might have deleterious effects on MSCs. Therefore, this study was conducted to investigate the effects of inflammatory synovial fluid and proinflammatory cytokines priming on viability and plasticity of equine MSCs. Equine bone marrow derived MSCs (eBM-MSCs) from three animals were cultured for 72 h in media supplemented with: 20% inflammatory synovial fluid (SF); 50 ng/mL IFN-γ and TNF-α (CK50); and 20 ng/mL IFN-γ and TNF-α (CK20). Proliferation assay and expression of proliferation and apoptosis-related genes showed that SF exposed-eBM-MSCs maintained their viability, whereas the viability of CK primed-eBM-MSCs was significantly impaired. Tri-lineage differentiation assay revealed that exposure to inflammatory synovial fluid did not alter eBM-MSCs differentiation potential; however, eBM-MSCs primed with cytokines did not display osteogenic, adipogenic or chondrogenic phenotype. The inflammatory synovial environment is well tolerated by eBM-MSCs, whereas cytokine priming negatively affects the viability and differentiation abilities of eBM-MSCs, which might limit their in vivo efficacy.

Highlights • The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis. • Hip fracture in osteoporotic bones should be considered after muscle violent contraction that causes hip pain and functional impotence., Introduction Trochanteric hip fractures in elderly patients with osteoporosis are commonly caused by low energy trauma. The cardioversion therapy is an extremely rare cause of this type of fracture. Presentation of case We report the case of a woman with hip fracture after cardioversion. Discussion We discuss the production mechanism of this injury and the importance of the care of the osteoporotic bone under these therapies. Conclusion The propofol sedation should be complemented with skeletal muscle relaxants in the cardioversion therapy to avoid hip fracture in select patients with osteoporosis.

This paper considers the operation scheduling and planning of elective patients in the Orthopedic Department of the “Lozano Blesa” Hospital in Zaragoza. We assume an ordered list of patients that should be planned for surgery. We propose a mixed linear integer programming problem to obtain a utilization rate of 80% per room. The results are tested on some real data from the hospital and some simulation results are provided.