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Ponente: Claudio Mella. Clínica Alemana. Santiago de Chile

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Ponente: Jesús Mas. Traumavist. Clínica Vistahermosa. Alicante

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XVI Jornadas de Actualización en Cirugía Ortopédica y Traumatología

Un año más el Servicio de Cirugía Ortopédica y Traumatología organiza las Jornadas de Actualización, este año bajo el título: Artroscopia de Hombro: Preguntas y Respuestas. Al igual que en ediciones anteriores, el objetivo de esta decimosexta edición, es presentar los conceptos actuales en cirugía ortopédica a través de la experiencia de ponentes expertos.

El programa de este año, bajo la dirección del Dr. Juan Fco. Abellán (miembro de la Unidad de Hombro del Servicio de COT del Hospital Morales Meseguer) aborda los temas relacionados con la Artroscopia de hombro, principalmente la inestabilidad de hombro y la patología del manguito rotador. A lo largo de las dos sesiones del programa, los ponentes invitados presentaran su experienca en estas patologías, tanto sobre el diagnostico como el tratamiento. Puedes consultar el programa completo pinchando aquí.

Uno de los objetivos de este año es contestar a las preguntas que pueden surgir a la hora de manejar estas lesiones, y que no siempre tienen fácil solución. Por esto, se ha diseñado un programa a base de preguntas que serán contestadas por los ponentes y presentadas al final a modo de conclusiones. De esta manera, se pretende responder preocupaciones actuales en el tratamiento de la patología del hombro, especialmente de aquellos cirujanos que están comenzando a realizar artroscopias de hombro.

Además de las preguntas dentro del programa, queremos recoger aquellas que puedan preocupar a todos aquellos interesados en la patología de hombro. Por esto, tanto asistentes como no asistentes, podrán realizar sus preguntas a través del twitter de las Jornadas

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Uso de Xiapex® en la enfermedad de Dupuytren

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Información


La enfermedad de Dupuytren es un trastorno progresivo del tejido conjuntivo que afecta a la fascia palmar de la mano. Puede provocar contracturas en flexión de las articulaciones de los dedos, que conllevan un grado considerable de deterioro funcional e incapacidad. Xiapex® (colagenasa de Clostridium Histolyticum) se ha desarrollado como un tratamiento dirigido a la contractura de Dupuytren en pacientes con una cuerda palpable. Su actividad farmacológica consiste en la lisis selectiva de colágeno en el lugar de inyección, es decir, la cuerda de Dupuytren.

Consideraciones de administración


Se trata de un fármaco de acción local que no requiere exposición sistémica para ser eficaz. Cabe destacar que los tejidos de sostén de nervios, arterias y venas están compuestos principalmente de  colágeno tipo IV resistente a la acción de Xiapex®. El tratamiento con Xiapex® consiste en una inyección seguida de un procedimiento de extensión del dedo que se efectúa al día siguiente para romper la cuerda de Dupuytren. En la mayoría de casos se obtienen resultados satisfactorios tras la administración de una sola inyección, aunque también es posible que se necesite más de un ciclo de tratamiento.

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Ventajas del tratamiento con Xiapex®


La enfermedad de Dupuytren es de origen desconocido por lo que su tratamiento no es curativo. La cirugía es paliativa para mejorar la función de la mano, afectada por la contractura en flexión de los dedos afectados. Xiapex® se presenta como la única opción a la cirugía en esta patología, con una eficacia y seguridad demostrada con los datos que se conocen hasta el momento. Se aplicaría de forma ambulatoria en nuestra consulta externa, sin ningún tipo de hospitalización, y no requiere rehabilitación posterior ya que se ha demostrado suficiente la ferulización nocturna durante 3-4 meses y la realización de ejercicios activos por el paciente en su domicilio.

Indicaciones y contraindicaciones


El tratamiento con Xiapex® esta indicado si usted es adulto con enfermedad de Dupuytren con cuerda palpable que provoque contractura de uno o más dedos.

Las contraindicaciones para su uso incluyen: cirugía previa tendinosa en la mano afectada, tratamiento con tetraciclinas en los 14dias previos a al inyección, tratamiento con fluoroquinolonas concomitante, trastornos de la coagulación sanguínea, tratamiento con anticoagulante los 7 dias previos a la inyección, coexistencia de enfermedad autoinmune y embarazo. Usted debe poner en conocimiento de su médico si presenta alguna de las circunstancias anteriormente descritas.

Efectos secundarios después de la administración


Tras la administración de Xiapex® puede aparecer a nivel local inflamación de la mano, con equímosis (hematoma o morado), dolor leve, picor y adenopatías axilares transitoria (10%, con resolución espontánea en 1 mes). Tras el procedimiento de extensión puede aparecer como complicaciones la rotura de la piel, infección, lesión tendinosa, recidiva de la contractura, dolor regional complejo, etc. La eficacia y seguridad del fármaco se ha comprobado experimental y clínicamente, si bien al tratarse de un medicamento de reciente utilización podría presentar algún efecto de inmunización desconocido actualmente.

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Unidad Docente

La unidad docente del Servicio COT funciona desde 1998, año en el que se consigue por primera vez la acreditación docente (1 plaza) para la formación MIR en la especialidad de COT en nuestro Hospital.  El primer tutor fue el Ernesto González Rodríguez, que ejerció hasta octubre de 2002, siendo sustituido por Francisco Javier Carrillo Juliá. Desde 2009 la unidad docente cuenta con dos plazas anuales, debido al aumento de residentes, y desde 2010, Juan Francisco Abellán Guillén se ha sumado al Dr. Carrillo como tutor de residentes.


El objetivo básico de la Unidad Docente es ofrecer a los M.I.R. en formación los conocimientos básicos teórico-prácticos necesarios para enfrentarse a los problemas osteoarticulares que planteen los pacientes y realizar, de forma autónoma, una orientación diagnóstica correcta, así como aplicar un tratamiento adecuado. De forma complementaria se instruye en la realización de trabajos de investigación clínica para su publicación o presentación en forma de comunicaciones orales o póster en Congresos e inicio de la Tesis Doctoral.


EXTRUCTURA:

Jefe de Servicio

  • Jorge Rivkin Roich

Jefe de Sección

  • Jose Manuel Sarabia Condes

Facultativos Especialistas de Area

  • Juan Francisco Abellán Guillén (Tutor de residentes)
  • David Bo Rueda
  • Francisco Javier Carrillo Juliá (Tutor de Residentes)
  • Jose Antonio de Miguel Vielba
  • Diego Giménez Belmonte
  • Ernesto González Rodríguez
  • Alfonso Lison Torres
  • Eduardo Melendreras Montesinos
  • Eduardo Molina Hernández
  • María Rodríguez-Miñón Ferrán
  • César Pérez Jiménez
  • Luis Ruano García
  • Emilio Salmerón Martínez
  • Fernando Ubeda García
  • Pedro Villamor Redondo

Residentes actuales:

  • Josefina Andrés GrauR5
  • Felix Fernando ArroyoR4
  • Juan Eduardo Gil GómezR3
  • Francisco Peñalver AguirrreR3
  • Lázaro Ibáñez MartínezR2
  • Miguel Angel Sánchez CarrascoR2
  • Isabel Buendía Ayala R1
  • Ana Rodríguez Ortuño R1

Residentes anteriores (por año de finalización):

  • Angel Lax Pérez*2002
  • Silvio Villascusa Marín2003
  • Miguel Angel Moltó Precioso2004
  • David Bo Rueda2005
  • Victor Castillo Meseguer2006
  • Jose Antonio Cano2007
  • Jose Carlos López Gaspar2008
  • Gregorio Nicolás Serrano2009
  • Juan Francisco Abellán Guillén2010
  • Jerónimo Martínez Martínez 2011

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Taller de artroscopia de hombro

Bajo la coordinación de la Unidad del Hombro del Hospital Morales y dirigido por el Dr. Giménez, se ha realizado un taller de formación en artroscopia de hombro para los residentes de nuestro servicio.


El pasado 29 de noviembre, y con la colaboración de Aldimesa, se llevo a cabo un taller práctico de iniciación y técnicas avanzadas en cirugía artroscópica de hombro. Durante el mismo se abordaron conocimientos teóricos y prácticos, como la anatomia artroscópica, portales básicos y tratamiento de la inestabilidad glenohumeral y las roturas de manguito.

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Servicio de Cirugía Ortopédica y Traumatología

El Hospital Morales Meseguer se encuentra en el centro de la ciudad de Murcia (plano de situación) y cubre el área de salud de la Región de Murcia conocida como Área VI (Área Vega Media del Segura).

El Servicio de Cirugía Ortopédica y Traumatología (COT) está formado por un total de 17 especialistas en COT y 7 médicos en formación mediante el sistema MIR. En la actualidad se encuentra en la vanguardia de los métodos diagnósticos y de tratamiento de la patología ortopédica y traumatológica. Para permitir esta constante actualización, el servicio se encuentra organizados en Unidades, donde los distintos facultativos se dividen en grupos atendiendo a la especialización dentro de la patología del aparato locomotor. Las distintas unidades son: Cadera y pelvis, Hombro, Mano, Pie y Raquis.

Además de la actividad asistencial, el Servicio está comprometido con la actividad docente. Se encuenta integrado en el sistema de formación MIR de COT, recibiendo 2 médicos por año que se formarán como especialistas durante un periodo de 5 años. Miembros del servicio colaboran como profesores asociados en la formación de estudiantes de Medicina de la Universidad de Murcia. Y, desde hace ya 15 años, organiza anualmente las Jornadas de Actualización en COT, donde se discuten temas de actualidad gracias a la presencia de ponentes nacionales e internacionales.

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La docencia del Morales entre las 10 mejores de España

Según el diario redacción médica (www.redaccionmedica.com), el Hospital Morales Meseguer es uno de los 10 mejores lugares de España para realizar la residencia. Nuestro centro aparece destacado junto a los centros:

  • Hospital Universitario Vall d’Hebron (Barcelona)
  • Complejo Hospitalario Universitario A Coruña
  • Hospital Universitario La Paz (Madrid)
  • Hospital Universitario 12 de Octubre (Madrid)
  • Hospital Universitario La Fe (Valencia)
  • Hospital Universitario Virgen del Rocío (Sevilla)
  • Hospital General de Ciudad Real
  • Hospital Universitario de Bellvitge
  • Hospital Universitario Marqués de Valdecilla (Santander).

Accede a toda la información pinchando aquí.

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Estructura del Servicio

Jefe de Servicio

  • Jorge Rivkin Roich

Jefe de Sección

  • José Manuel Sarabia Condes

Facultativos Especialistas de Área

UNIDAD DE CADERA Y PELVIS

  • Alfonso Lison Torres
  • Eduardo Molina Hernández
  • Luis Ruano García

UNIDAD DE HOMBRO

  • Eduardo Melendreras Montesinos
  • Diego Giménez Belmonte
  • Juan Francisco Abellán Guillén

UNIDAD DE MANO

  • Francisco Javier Carrillo Juliá
  • María Rodríguez-Miñón Ferrán
  • Emilio José Salmerón Martínez
  • Jose Manuel Sarabia Condes
UNIDAD DE PIE

  • David Bo Rueda
  • Fernando Úbeda García
  • Pedro Villamor Redondo

UNIDAD DE RAQUIS

  • José Antonio De Miguel Vielba
  • Ernesto González Rodríguez
  • Cesar Pérez Jiménez

Residentes actuales:

  • Juan Eduardo Gil Gómez R5
  • Francisco Peñalver Aguirrre R5
  • Lázaro Ibáñez Martínez R4
  • Miguel Angel Sánchez Carrasco R4
  • Isabel Buendia Ayala R3
  • María Dolores Martínez Trinidad R2
  • Sara Sánchez López R2
  • María García Morales R1

Residentes anteriores (por año de finalización):

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  • Angel Lax Pérez* 2002
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  • Miguel Angel Moltó Precioso 2004
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  • Jose Antonio Cano 2007
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  • Josefina Andrés Grau 2012
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