No abstract

Bone tumors of the clavicle are exceedingly rare with a reported frequency of less than 1% of all bone tumors. [1] Because of this, most doctors have limited experience in the diagnosis and treatment of these tumors. The prevalence of aneurysmal bone cyst (ABC) is greater in the first two decades of life, due to its relationship with the immature and growing skeleton, affecting almost twice as many males as females. [2] It is often found in long bones, particularly in the metaphyseal area of the femur and tibia. It can also be located in the spine and pelvis, [3] but its location in the clavicle is very rare. [4] Differential diagnosis should be considered with essential bone cyst, giant cell tumor, osteoblastoma, chondromyxoid fibroma, and telangiectatic osteosarcoma. [4,5] In this article, we propose a description of a simple technique, some considerations about treatment options in selected ABC located in clavicle during childhood, and a follow-up of more than two years. [6] CASE REPORT A seven-year-old boy was referred to our clinic due to a painful tumor of progressive growth, in the lateral-The clavicle is an infrequent location for primary tumors in general, and aneurysmal bone cyst (ABC) of the clavicle is particularly rare. The challenge of the functional and esthetic result in the treatment of these lesions in the pediatric population is high when considering the reconstruction of critical bone defects. In this article, we present the case of a seven-year-old boy with an ABC in the middle third of the clavicle, treated by resection and reconstruction with free autograft of the fibula stabilized by using an intramedullary titanium nail. We offer a description of the used technique, considerations about treatment options in children, and a follow-up of more than two-and-a-half years.

Epidemiología, resultados clínicos y tasa de éxito en cirugía preservadora de cadera en la necrosis avascular de cabeza femoral Epidemiology, clinical results and success rate in hip preservation surgery in avascular osteonecrosis of the femoral head

Introducción La artroplastia total de cadera es un procedimiento quirúrgico exitoso y seguro, pero que conlleva una inherente perdida sanguínea asociada. Cuando esta cirugía se lleva a cabo de forma programada, la implantación de un abordaje multimodal de Patient Blood Management (PBM), permitirá reducir significativamente las necesidades transfusionales. Objetivo Presentar los resultados clínico-analíticos y la incidencia transfusional tras la implantación de un protocolo de PBM en aquellos pacientes que van a someterse a una cirugía protésica de cadera. Material y métodos Estudio restrospectivo, unicentrico, observacional y analítico, entre aquellos pacientes sometidos a una artroplastia primaria de cadera electiva entre enero de 2017 y Febrero de 2019. En todos ellos, se ha aplicado un protocolo de PBM, centrado en el desarrollo de un programa de optimización de la anemia preoperatoria, la utilización de ácido tranexámico tópico y la adopción de una política transfusional restrictiva. Resultados El estudio incluyó un total de 384 pacientes, donde únicamente 9 precisaron transfusión de sangre alogénica (Tasa transfusional: 2,34%). En el análisis de los pacientes transfundidos, se encontró que presentaban una mayor estancia hospitalaria (8 ±2,9 Vs 5,3 ±2,9 días; p=0,007)  y un mayor índice de complicaciones (22,2% vs 3,9%; p=0,017), respecto a aquellos que eludieron la TSA. Conclusión La aplicación de un adecuado protocolo multimodal de PBM, nos acerca a la utopía de una cirugía sin sangre en la cirugía protésica, resultando un modelo costo-efectivo que permite reducir de forma significativa la TSA en la artroplastia primaria de cadera.