Colegio Mexicano de Ortopedia y Traumatología

Colegio Mexicano de Ortopedia y Traumatología
CMO en linea....

viernes, 31 de agosto de 2012

manejando las lesiones ortopédicas en el paciente hemofilico adulto


Hemofilia XXI A.C. les transmite la invitación que nos hace el Dr. Armando Hernandez Salgado a la conferencia sobre el manejando las lesiones ortopédicas en el paciente hemofilico adulto por el próximo miércoles 5 de septiembre. La tele conferencia se transmitirá a través de Facebook en el Grupo Ortopedia Mixta y muy posiblemente por nuestro grupo de Hemofilia XXI A.C.
La transmisión será a las 18:30 horas en el Horario del Centro de México, saludos.
http://www.facebook.com/groups/156670141102728/
  • Servicio de Ortopedia Mixta, ubicado en el segundo piso del Hospital de Ortopedia Dr. Victorio de la Fuente Narváez IMSS Ciudad de México, Distrito Federal AVISO: El contenido de las presentaciones in...

Carrera 5-10 K. Celebra el movimiento


Iniciativa de investigación conjunta: La patología musculoesquelética en los servicios de urgencias

http://reumails.blogspot.mx/2012/08/iniciativa-de-investigacion-conjunta-la.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed:+ReumailsReumatologaAlDa+(Reumails:+Reumatolog%C3%ADa+al+d%C3%ADa)


VIERNES, 31 DE AGOSTO DE 2012

Iniciativa de investigación conjunta: La patología musculoesquelética en los servicios de urgencias

Como ya hemos señalado en más de una entrada previa, la patología musculoesquelética no relacionada con traumatismos representa un proporción importante de los motivos de consulta en los centros de atención primaria.
También hemos destacado que existen muy pocos estudios que determinen la prevalencia de este tipo de patologías en los servicios de urgencias.
El objetivo de la presente iniciativa es determinar qué proporción de la asistencia de nuestros servicios de urgencia se dedica a la patología musculoesquelética y que impacto tiene en el consumo de tiempo y de recursos y en qué medida se generan nuevas consultas repetidas por el mismo motivo.

En un estudio realizado en un servicio de urgencias de Madrid y que está en vías de publicación hemos encontrado una prevalencia del 12% y es nuestro interés obtener una muestra más grande para conocer el peso real de esta patología en urgencias a nivel regional o nacional.

Si algun lector de este blog tiene interés en conocer más de esta iniciativa y participar de un estudio de prevalencias, multicéntrico quedamos a vuestra disposición.

Dr. Carlos A Guillen

Sesion de residentes del CMO. 30/VIII/2012 .Preguntas

Después de las exposiciones, vinieron las preguntas...

http://livestre.am/46Vgq





y las fotografías de nuestros ponentes




"Técnicas quirúrgicas y procedimientos en ortopedia y traumatología infantil y del adolescentes"


Jueves, 30 de Agosto de 2012 00:00
Más de 80 participantes de todo el continente

"Técnicas quirúrgicas y procedimientos en ortopedia y traumatología infantil y del adolescentes"




Profesor Miguel Soto y los doctores Julio Cárdenas y Juan Carlos Hernández.

El primer curso de esta naturaleza en Latinoamérica se dictó entre el 20 y 24 de agosto de 2012 en el Hotel Sheraton y el Instituto de Anatomía de la Facultad de Medicina de la Universidad de Chile, cuyo sello distintivo lo dio el trabajo práctico realizado en nuestro plantel.

Así lo explicó la doctora Dalia Sepúlveda, directora del encuentro, quien agradeció la sinergia entre la Sociedad Chilena de Ortopedia y Traumatología, SCHOT, y el Instituto de Anatomía, pues permitió que los más de 80 participantes de todo el continente pudieran capacitarse en el manejo de diferentes técnicas quirúrgicas propias de la disciplina aplicadas a los pacientes pediátricos, gracias al taller práctico sobre material cadavérico.

De esta forma, los inscritos conocieron la teoría y práctica de las más novedosas técnicas quirúrgicas y métodos no quirúrgicos aplicables a lesiones relacionadas con diversos traumas y al tratamiento y corrección de diferentes patologías, como la displasia de cadera o malformaciones, como el pie bot. "Asimismo, se practicaron abordajes que protejan la indemnidad de elementos que podrían sufrir lesiones durante las intervenciones", añadió.

En el encuentro participaron docentes de Venezuela, Estados Unidos, Brasil, Suiza y Argentina, además de destacados especialistas nacionales. Según añade el profesor Miguel Soto, co director científico del curso y académico del Programa de Anatomía y Biología del Desarrollo del Instituto de Ciencias Biomédicas, la fortaleza de esta iniciativa se dio en la posibilidad de hacer trabajos prácticos sobre piezas cadavéricas, lo que permite un mejor acercamiento y aprendizaje por parte de los especialistas.


Cecilia Valenzuela


Contacto-Prensa Facultad

SANTANDER HIP MEETING 2013. Artroscopia de cadera y Artroplastia

The Once and Future Way to Run


The Once and Future Way to Run

Jorg Badura for The New York Times
The Lost Secret of Running: Christopher McDougall demonstrates a lost running technique from the 1800s called the 100-Up.
Multimedia

Well

Comment Share your thoughts on this article at the Well blog.
If everything comes together just right, you’ll be exactly where Larson was one Sunday morning in September: peeking out from behind a tree on Governors Island in New York Harbor, his digital video camera nearly invisible on an ankle-high tripod, as the Second Annual New York City Barefoot Run got under way about a quarter-mile up the road. Hundreds of runners — men and women, young and old, athletic and not so much so, natives from 11 different countries — came pattering down the asphalt straight toward his viewfinder.
About half of them were actually barefoot. The rest woreVibram FiveFingers — a rubber foot glove with no heel cushion or arch support — or Spartacus-style sandals, or other superlight “minimalist” running shoes. Larson surreptitiously recorded them all, wondering how many (if any) had what he was looking for: the lost secret of perfect running.
It’s what Alberto Salazar, for a while the world’s dominant marathoner and now the coach of some of America’s top distance runners, describes in mythical-questing terms as the “one best way” — not the fastest, necessarily, but thebest: an injury-proof, evolution-tested way to place one foot on the ground and pick it up before the other comes down. Left, right, repeat; that’s all running really is, a movement so natural that babies learn it the first time they rise to their feet. Yet sometime between childhood and adulthood — and between the dawn of our species and today — most of us lose the knack.
We were once the greatest endurance runners on earth. We didn’t have fangs, claws, strength or speed, but the springiness of our legs and our unrivaled ability to cool our bodies by sweating rather than panting enabled humans to chase prey until it dropped from heat exhaustion. Some speculate that collaboration on such hunts led to language, then shared technology. Running arguably made us the masters of the world.
So how did one of our greatest strengths become such a liability? “The data suggests up to 79 percent of all runners are injured every year,” says Stephen Messier, the director of the J. B. Snow Biomechanics Laboratory at Wake Forest University. “What’s more, those figures have been consistent since the 1970s.” Messier is currently 11 months into a study for the U.S. Army and estimates that 40 percent of his 200 subjects will be hurt within a year. “It’s become a serious public health crisis.”
Nothing seems able to check it: not cross-training, not stretching, not $400 custom-molded orthotics, not even softer surfaces. And those special running shoes everyone thinks he needs? In 40 years, no study has ever shown that they do anything to reduce injuries. On the contrary, the U.S. Army’s Public Health Command concluded in a report in 2010, drawing on three large-scale studies of thousands of military personnel, that using shoes tailored to individual foot shapes had “little influence on injuries.”
Two years ago, in my book, “Born to Run,” I suggested we don’t need smarter shoes; we need smarter feet. I’d gone into Mexico’s Copper Canyon to learn from the Tarahumara Indians, who tackle 100-mile races well into their geriatric years. I was a broken-down, middle-aged, ex-runner when I arrived. Nine months later, I was transformed. After getting rid of my cushioned shoes and adopting the Tarahumaras’ whisper-soft stride, I was able to join them for a 50-mile race through the canyons. I haven’t lost a day of running to injury since.
“Barefoot-style” shoes are now a $1.7 billion industry. But simply putting something different on your feet doesn’t make you a gliding Tarahumara. The “one best way” isn’t about footwear. It’s about form. Learn to run gently, and you can wear anything. Fail to do so, and no shoe — or lack of shoe — will make a difference.
That’s what Peter Larson discovered when he reviewed his footage after the New York City Barefoot Run. “It amazed me how many people in FiveFingers were still landing on their heels,” he says. They wanted to land lightly on their forefeet, or they wouldn’t be in FiveFingers, but there was a disconnect between their intentions and their actual movements. “Once we develop motor patterns, they’re very difficult to unlearn,” Larson explains. “Especially if you’re not sure what it’s supposed to feel like.”
The only way to halt the running-injury epidemic, it seems, is to find a simple, foolproof method to relearn what the Tarahumara never forgot. A one best way to the one best way.
Earlier this year, I may have found it. I was leafing through the back of an out-of-print book, a collection of runners’ biographies called “The Five Kings of Distance,” when I came across a three-page essay from 1908 titled “W. G. George’s Own Account From the 100-Up Exercise.” According to legend, this single drill turned a 16-year-old with almost no running experience into the foremost racer of his day.
I read George’s words: “By its constant practice and regular use alone, I have myself established many records on the running path and won more amateur track-championships than any other individual.” And it was safe, George said: the 100-Up is “incapable of harm when practiced discreetly.”
Could it be that simple? That day, I began experimenting on myself.
When I called Mark Cucuzzella to tell him about my find, he cut me off midsentence. “When can you get down here?” he demanded.
“Here” is Two Rivers Treads, a “natural” shoe store sandwiched between Maria’s Taqueria and German Street Coffee & Candlery in Shepherdstown, W.Va., which, against all odds, Cucuzzella has turned into possibly the country’s top learning center for the reinvention of running.
“What if people found out running can be totally fun no matter what kind of injuries they’ve had?” Cucuzzella said when I visited him last summer. “What if they could see — ” he jerked a thumb back toward his chest — “Exhibit A?”
Cucuzzella is a physician, a professor at West Virginia University’s Department of Family Medicine and an Air Force Reserve flight surgeon. Despite the demands of family life and multiple jobs, he still managed enough early-morning miles in his early 30s to routinely run marathons at a 5:30-per-mile pace. But he constantly battled injuries; at age 34, severe degenerative arthritis led to foot surgery. If he continued to run, his surgeon warned, the arthritis and pain would return.
Cucuzzella was despondent, until he began to wonder if there was some kind of furtive, Ninja way to run, as if you were sneaking up on someone. Cucuzzella threw himself into research and came across the work of, among others, Nicholas Romanov, a sports scientist in the former Soviet Union who developed a running technique he called the Pose Method. Romanov essentially had three rules: no cushioned shoes, no pushing off from the toes and, most of all, no landing on the heel.
Once Cucuzzella got used to this new style, it felt suspiciously easy, more like playful bouncing than serious running. As a test, he entered the Marine Corps Marathon. Six months after being told he should never run again, he finished in 2:28, just four minutes off his personal best.
“It was the beginning of a new life,” Cucuzzella told me. “I couldn’t believe that after a medical education and 20 years of running, so much of what I’d been taught about the body was being turned on its head.” Two weeks before turning 40, he won the Air Force Marathon and has since completed five other marathons under 2:35. Shortly before his 45th birthday this past September, he beat men half his age to win the Air Force Marathon again. He was running more on less training than 10 years before, but “felt fantastic.”
When he tried to spread the word, however, he encountered resistance. At a Runner’s World forum I attended before the Boston Marathon in April 2010, he told the story of how he bounced back from a lifetime of injuries by learning to run barefoot and relying on his legs’ natural shock absorption. Martyn Shorten, the former director of the Nike Sports Research Lab who now conducts tests on shoes up for review in Runner’s World, followed him to the microphone. “A physician talking about biomechanics — I guess I should talk about how to perform an appendectomy,” Shorten said. He then challenged Cucuzzella’s belief that cushioned shoes do more harm than good.
No matter. Cucuzzella went home and began hosting his own conferences. Peter Larson traveled from New Hampshire for Cucuzzella’s first gathering on a snowy weekend this past January. “I was a bit curious about how many people might show up to such an event in rural West Virginia,” Larson says. “Were the panelists going to outnumber the audience?” In fact, more than 150 attendees crowded right up to the dais.
Since then, West Virginia has become a destination for a growing number of those who are serious about the grass-roots reinvention of running. Galahad Clark, a seventh-generation shoemaker who created the Vivobarefoot line, flew in from London with the British running coach Lee Saxby for a one-day meeting with Cucuzzella. International researchers like Craig Richards, from Australia, and Hiro Tanaka, chairman of Exercise Physiology at the University of Fukuoka, have also visited, as well as scientists from a dozen different American states.
“He has turned a small town in an obese state into a running-crazed bastion of health,” Larson says. “Mark’s effort in transforming Shepherdstown is a testament to what a single person can accomplish.”
Not that he has everything figured out. I was at one of Cucuzzella’s free barefoot running clinics in May when he confronted his big problem: how do you actually teach this stuff? He had about 60 of us practicing drills on a grassy playground. “Now to run,” he said, “just bend forward from the ankles.” We all looked down at our ankles.
“No, no,” Cucuzzella said. “Posture, remember? Keep your heads up.”
We lifted our heads, and most of us then forgot to lean from the ankles. At that moment, a young girl flashed past us on her way to the monkey bars. Her back was straight, her head was high and her bare feet skittered along right under her hips.
“You mean like — ” someone said, pointing after the girl.
“Right,” Cucuzzella said. “Just watch her.”
So what ruined running for the rest of us who aren’t Tarahumara or 10 years old?
Back in the ’60s, Americans “ran way more and way faster in the thinnest little shoes, and we never got hurt,” Amby Burfoot, a longtime Runner’s World editor and former Boston Marathon champion, said during a talk before the Lehigh Valley Half-Marathon I attended last year. “I never even remember talking about injuries back then,” Burfoot said. “So you’ve got to wonder what’s changed.”
Bob Anderson knows at least one thing changed, because he watched it happen. As a high-school senior in 1966, he started Distance Running News, a twice-yearly magazine whose growth was so great that Anderson dropped out of college four years later to publish it full time as Runner’s World. Around then, another fledgling operation called Blue Ribbon Sports was pioneering cushioned running shoes; it became Nike. Together, the magazine and its biggest advertiser rode the running boom — until Anderson decided to see whether the shoes really worked.
“Some consumer advocate needed to test this stuff,” Anderson told me. He hired Peter Cavanagh, of the Penn State University biomechanics lab, to stress-test new products mechanically. “We tore the shoes apart,” Anderson says. He then graded shoes on a scale from zero to five stars and listed them from worst to first.
When a few of Nike’s shoes didn’t fare so well in the 1981 reviews, the company pulled its $1 million advertising contract with Runner’s World. Nike already had started its own magazine, Running, which would publish shoe reviews and commission star writers like Ken Kesey and Hunter S. Thompson.
“Nike would never advertise with me again,” Anderson says. “That hurt us bad.” In 1985, Anderson sold Runner’s World to Rodale, which, he says, promptly abolished his grading system. Today, every shoe in Runner’s World is effectively “recommended” for one kind of runner or another. David Willey, the magazine’s current editor, says that it only tests shoes that “are worth our while.” After Nike closed its magazine, it took its advertising back to Runner’s World. (Megan Saalfeld, a Nike spokeswoman, says she was unable to find someone to comment about this episode.)
“It’s a grading system where you can only get an A,” says Anderson, who went on to become the founder and chief executive of Ujena Swimwear.
Just as the shoe reviews were changing, so were the shoes: fear, the greatest of marketing tools, entered the game. Instead of being sold as performance accessories, running shoes were rebranded as safety items, like bike helmets and smoke alarms. Consumers were told they’d get hurt, perhaps for life, if they didn’t buy the “right” shoes. It was an audacious move that flew in the face of several biological truths: humans had thrived as running animals for two million years without corrective shoes, and asphalt was no harder than the traditional hunting terrains of the African savanna.
In 1985, Benno Nigg, founder and currently co-director of the University of Calgary’s Human Performance Lab, floated the notion that impact and rear-foot motion (called pronation) were dangerous. His work helped spur an arms race of experimental technology to counter those risks with plush heels and wedged shoes. Running magazines spread the new gospel. To this day, Runner’s World tells beginners that their first workout should be opening their wallets: “Go to a specialty running store . . . you’ll leave with a comfortable pair of shoes that will have you running pain- and injury-free.”
Nigg now believes mistakes were made. “Initial results were often overinterpreted and were partly responsible for a few ‘blunders’ in sport-shoe construction,” he said in a speech to the International Society of Biomechanics in 2005. The belief in the need for cushioning and pronation control, he told me, was, in retrospect, “completely wrong thinking.” His stance was seconded in June 2010, when The British Journal of Sports Medicine reported that a study of 105 women enrolled in a 13-week half-marathon training program found that every single runner who was given motion-control shoes to control excess foot pronation was injured. “You don’t need any protection at all except for cold and, like, gravel,” Nigg now says.
Of course, the only way to know what shoes have done to runners would be to travel back to a time when no one ever wore them. So that’s what one anthropologist has effectively done. In 2009, Daniel Lieberman, chairman of Harvard’s human evolutionary biology department, located a school in Kenya where no one wore shoes. Lieberman noticed something unusual: while most runners in shoes come down hard on their heels, these barefoot Kenyans tended to land softly on the balls of their feet.
Back at the lab, Lieberman found that barefoot runners land with almost zero initial impact shock. Heel-strikers, by comparison, collide with the ground with a force equal to as much as three times their body weight. “Most people today think barefoot running is dangerous and hurts, but actually you can run barefoot on the world’s hardest surfaces without the slightest discomfort and pain.”
Lieberman, who is 47 and a six-time marathoner, was so impressed by the results of his research that he began running barefoot himself. So has Irene Davis, director of Harvard Medical School’s Spaulding National Running Center. “I didn’t run myself for 30 years because of injuries,” Davis says. “I used to prescribe orthotics. Now, honest to God, I run 20 miles a week, and I haven’t had an injury since I started going barefoot.”
Last fall, at the end of a local 10-mile trail race, I surprised myself by finishing five minutes faster than I had four years ago, when I was in much better shape. I figured the result was a fluke — until it happened again. No special prep, awful travel schedule and yet a personal best in a six-mile race.
“I don’t get it,” I told Cucuzzella this past June when we went for a run together through the Shepherd University campus in Shepherdstown. “I’m four years older. I’m pretty sure I’m heavier. I’m not doing real workouts, just whatever I feel like each day. The only difference is I’ve been 100-Upping.”
It was five months since I discovered W.S. George’s “100-Up,” and I’d been doing the exercise regularly. In George’s essay, he says he invented the 100-Up in 1874, when he was an 16-year-old chemist’s apprentice in England and could train only during his lunch hour. By Year 2 of his experiment, the overworked lab assistant was the fastest amateur miler in England. By Year 5, he held world records in everything from the half-mile to 10 miles.
So is it possible that a 19th-century teenager succeeded where 21st-century technology has failed?
“Absolutely, yes,” says Steve Magness, a sports scientist who works with top Olympic prospects at Nike’s elite “Oregon Project.” He was hired by Alberto Salazar to create, essentially, a squad of anti-Salazars. Despite his domination of the marathon in the ’80s, Salazar was plagued with knee and hamstring problems. He was also a heel-striker, which he has described as “having a tire with a nail in it.” Magness’s brief is to find ways to teach Nike runners to run barefoot-style and puncture-proof their legs.
“From what you’re telling me, it sounds promising,” Magness told me. “I’d love to see it in action.”
Mark Cucuzzella was just as eager. “All right,” he said in the middle of our run. “Let’s get a look at this.” I snapped a twig and dropped the halves on the ground about eight inches apart to form targets for my landings. The 100-Up consists of two parts. For the “Minor,” you stand with both feet on the targets and your arms cocked in running position. “Now raise one knee to the height of the hip,” George writes, “bring the foot back and down again to its original position, touching the line lightly with the ball of the foot, and repeat with the other leg.”
That’s all there is to it. But it’s not so easy to hit your marks 100 times in a row while maintaining balance and proper knee height. Once you can, it’s on to the Major: “The body must be balanced on the ball of the foot, the heels being clear of the ground and the head and body being tilted very slightly forward. . . . Now, spring from the toe, bringing the knee to the level of the hip. . . . Repeat with the other leg and continue raising and lowering the legs alternately. This action is exactly that of running.”
Cucuzzella didn’t like it as a teaching method — he loved it. “It makes so much physiological and anatomical sense,” he said. “The key to injury-free running is balance, elasticity, stability in midstance and cadence. You’ve got all four right there.”
Cucuzzella began trying it himself. As I watched, I recalled another lone inventor, a Czechoslovakian soldier who dreamed up a similar drill: he’d throw dirty clothes in the bathtub with soap and water, then jog on top. You can’t heel strike or overstride on slippery laundry. There’s only one way to run in a tub: the one best way.
At the 1952 Olympics, Emil Zatopek became the only runner ever to win gold medals in all three distance events: 5,000 meters, 10,000 meters and the marathon, the first he ever ran. Granted, “the Human Locomotive” wasn’t a pretty sight. During his final push to the finish line, his head would loll and his arms would grab at the air “as if he’d just been stabbed through the heart,” as one sportswriter put it.
But from the waist down, Zatopek was always quick, light and springy, like a kid swooping across a playground — or like this once-arthritic physician in front of me, laughing with excitement as he hopped up and down in his bare feet in a parking lot.
This article has been revised to reflect the following correction:
Correction: November 20, 2011
A chart on Nov. 6 with an article about the correct way to run misstated the proper position of the elbow in relation to the opposite knee as it moves forward. The elbow should also move forward, not backward.

A Once-Unthinkable Choice for Amputees


http://www.nytimes.com/2012/05/15/health/losing-more-to-gain-more-amputees-once-unthinkable-choice.html?pagewanted=all

A Once-Unthinkable Choice for Amputees

Josh Haner/The New York Times
Ann Kornhauser of Hicksville, N.Y., decided to lose more of her leg to benefit from a new prosthetic.

Five years ago, on a muggy August morning in Hicksville, N.Y., Ann Kornhauser was out walking her golden retriever when bones in her left foot suddenly cracked. Ms. Kornhauser, then in her late 50s, soon learned why: doctors discovered a rare tumor in her foot. They amputated half of it.
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The prosthetic foot she received afterward left her in constant pain; she often cried in her car after trips to the grocery store because she dreaded carrying the bags into the house. Her prosthetist offered a solution. Artificial limbs had greatly improved, he said, and she could benefit from one of the new high-tech models — but it would fit only if her left leg was amputated below the knee.
The idea of losing the rest of her leg, which was healthy enough, seemed preposterous and frightening. But after two years of discomfort, Ms. Kornhauser decided to do it.
“All my family said was, ‘You’re going to be sitting there without a leg.’ But they didn’t know what I knew,” she said. “I knew it was going to look like a leg and that people ran marathons on them. I knew that I would have a life.”
During a recent interview, the cheerful 63-year-old grandmother pulled up her gray slacks to reveal a prosthetic leg with a fleshlike surface and pedicured toes. The mechanical leg has a realistic appearance, with a custom silicone skin and an ankle that can be adjusted for various heel heights; several similar foot-ankle systems are marvels of microprocessors, including motion sensors. “I was able to walk again,” she said. “And it looks real.”
Approximately two million people in the United States are living with amputations, according to the Amputee Coalition, a national advocacy group. But as artificial limbs are infused with increasingly sophisticated technology, many amputees are making a once-unthinkable choice. Instead of doing everything possible to preserve and live with whatever is left of their limbs, some are opting to amputate more extensively to regain something more akin to normal function.
Occasionally this choice is made by someone with a missing hand or arm. But more common are amputations below the knee, which permit patients like Ms. Kornhauser to take advantage of robotic and fleshlike prosthetics.
Bionic, or lifelike, prosthetics with custom skins, motors and microchips that replicate natural human motions are edging older models out of the market. The South African runner Oscar Pistorius, a double amputee, has even been accused of having an unfair advantage over competitors because he runs on J-shaped carbon fiber blades.
Amputees “are realizing they can do everything that they did before,” said Amy Palmiero-Winters, 39, a celebrated ultramarathon runner who lost her left leg in a motorcycle accident when she was 24. She now works at A Step Ahead, a Long Island prosthetics clinic. “They look at people today and see the different things that they’re doing and how it’s more out in the open and accepted.”
And not just accepted: While the loss of a limb remains a medical trauma, many amputees have come to embrace their bionic enhancements. Many “have little desire for the artificial limb to look human,” said Hugh Herr, who heads the biomechatronics research group at the Media Lab at the Massachusetts Institute of Technology, which is developing wearable robotic devices. “They want it to look interesting and have a machine beauty.”
Regaining Active Lives
One day in the summer of 2003, David Rozelle, an Army captain, lay in a hospital outside Baghdad, his rightfoot mangled by a land mine. Doctors amputated it just above his ankle.
With an artificial foot, Captain Rozelle, who lives near Boulder, Colo., managed to regain part of his old life. He competed in triathlons and returned to duty in Iraq; he is now a major. But two and a half years after his amputation, he told his surgeon that he wanted nine inches of his leg removed so that he could benefit from a new below-the-knee prosthesis. His doctor was aghast.
“The medical community is focused completely on salvaging limbs,” said Major Rozelle, 39. “There’s actually a disadvantage to having extra limb length, because you can’t fit correctly into prosthetic devices.”
He had the operation and now owns several models of sophisticated robotic legs, which he uses for everyday activities and for his favorite sports, like skiing.
Many amputees opting for more extensive surgery are athletes like Major Rozelle hoping to regain active lives.
At 21, Tom White was run over by a truck while riding his motorcycle. His left foot was amputated and then reattached, something he said he “begged” his doctors to do. After 19 operations and two years on crutches, he walked with a limp but went on backpacking trips, ran marathons and generally tried to keep in shape and happy.
But as the years went by, the discomfort grew worse. Arthritis attacked his fused joints, and while there had always been pain when he ran, he simply couldn’t tolerate the new sharp pangs.
“The last couple of years, boy, my life started closing in on me because I couldn’t run anymore,” said Dr. White, 51, a family physician in Buena Vista, Colo. “It got so that doing something like taking a hike wasn’t fun anymore because it hurt too much.”
Dr. White had his left leg amputated just below the knee to get a sleek carbon-fiber foot. Three years later, he has started training for races again. “I made the decision to have an elective amputation so that I could have a chance to get back to my life,” he said. “It just dawned on me — the technology is amazing, and I would be better off.”
Amputees’ families, who are understandably worried and confused, are rarely as enthusiastic about the drastic procedures, however. For Michael LaForgia, it took a lot of persuading — and collecting the testimonies of other amputees who had done the same — to get his wife on board.
Mr. LaForgia, a marathoner and program manager for JPMorgan Chase in Smithtown, N.Y., contracted bacterial meningitis in 2005 and lost the toes of his left foot and the toes, heel and arch of his right foot. Doctors tried to rebuild the right foot with muscle removed from his back, but he couldn’t wear normal shoes, run, bike or continue coaching his children’s baseball and soccer teams. He was constantly hunched over.
Mr. LaForgia was “relieved and excited” to amputate his right leg a year and a half later to get a high-activity prosthesis. He later got a partial foot prosthetic with a running foot for his left. “I so much wanted to get rid of that foot, because it stood for everything I couldn’t do,” said Mr. LaForgia, 46. “I’ve got a $150 pair of Cole Haan shoes I can wear.”
Ever More Sophisticated
The technology in the newer prosthetics is moving rapidly ahead. Dr. Herr, the M.I.T. professor, has founded a startup called iWalk devoted to making next-generation prosthetics. The company’s first product, a bionic foot and ankle, resulted from careful modeling of the muscles, tendons and spinal reflexes used in human walking.
The foot can sense the actions of the wearer and the terrain on which the person is walking and adjust accordingly. Its microprocessors help coordinate reflexlike responses to the user’s motions, and its robotics simulate the action of missing calf muscles and Achilles tendons.
According to Dr. Herr, an amputee using the foot uses the same amount of energy while walking as someone with biological limbs — a first for a prosthesis. But it is not cheap — about $70,000. While insurers will pay for basic protheses, they generally do not pay for high-end artificial limbs like these.
And these devices are likely to become more sophisticated. At Johns Hopkins University, researchers financed by the Defense Advanced Research Projects Agency have been working to create new prosthetics for soldiers with upper extremity amputations. Until recently, most of them wore only a basic hook.
The goal is to build artificial limbs that resemble human arms in dexterity, strength, size and weight — and that veterans one day may control with their brains. The scientists plan to insert a small array of electrodes into the cortex, the brain’s top layer, or into peripheral nerves. The hope is that by capturing these nerve signals and transmitting them to an artificial limb, thought can be turned into motion. Hopkins researchers are even planning to test a limb that might allow amputees to feel pressure, heat and cold.
Intelligent artificial limbs like these are still years away, and it will be a long time before the Bionic Man or Woman is a reality. But the improving technology already has provided amputees with one invaluable benefit.
“I don’t feel ugly anymore,” Dr. White said. “I feel like a normal guy.”
This article has been revised to reflect the following correction:
Correction: May 20, 2012
An article on Tuesday about the choice by some people to amputate more of a limb to take advantage of improvements in prostheses described incorrectly the artificial leg used by Ann Kornhauser, who lost part of a foot because of a tumor and later opted to amputate below the knee. Ms. Kornhauser’s leg has a realistic appearance and an adjustable ankle, as the article noted, but it is a mechanical prosthesis — not “a marvel of microprocessors, including motion sensors,” as are some other foot-ankle prostheses. The error was repeated in a caption
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Actualización en artroplastia de cadera y rodilla


Actualización en artroplastia de cadera y rodilla

Buenos días, invitándolos al curso de alta especialidad: actualización en artroplastia de cadera y rodilla......






1°er Congreso internacional y 10 Curso Taller de Patología Quirúrgica del Pie

Terminamos el mes de agosto, recordandoles que están a tiempo para inscribirse en este Congreso-Taller, tenemos a su disposición becas del 50% de descuento para la inscripción de este evento, solo la tienen que solicitar a:

 bibliomanazteca@yahoo.com.mx

El congreso tiene una inversión de 2000 pesos, así que solo tendrán que pagar 1000!!! , a continuación añado los tripticos:









Caso, para comentar


Continuando con el caso, las placas fallaron y decidimos drenar el aeronave y retirar las placas, la misma fibrosis mantuvo la reducción, por lo k quitamos el componente tibial, colocamos uno de revisión, y acoplamos un vástago de 220x9 con orificios para su bloqueo, actualmente consolidada y con apoyo total.