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E Carlos Rodriguez-Merchan

Publications and source records attributed to E Carlos Rodriguez-Merchan.

9 recordsLinked to original sources
PubMed2005

Hemophilia orthopedic management with emphasis on developing countries.

The articular problems of patients with hemophilia begin in infancy when minor injuries result in hemarthroses. Early continuous prophylaxis (from cradle to college) is of paramount importance because the immature skeleton is very sensitive to the complications of hemophilia; severe structural deficiencies may develop quickly. If continuous prophylaxis is not feasible owing to the expense of the clotting material or lack of venous access, then a major hemarthrosis must be treated aggressively to prevent the development of synovitis, recurrent joint bleeds, and ultimately end-stage arthritis. Once synovitis has developed, which bleeding will make inevitable, the aim should be to treat it as soon as possible. There are conservative (synoviorthesis) and operative (open or arthroscopic synovectomy) methods. Between the second and fourth decades, many patients with hemophilia develop articular complications. Once this has occurred, treatment modalities such as alignment osteotomies, joint debridement, arthrodesis, and arthroplasties are possible. Should surgery be required, one should consider multiple procedures.

Child↗
PubMed2004

Elective orthopedic surgery for hemophilia patients with inhibitors: New opportunities.

We report a series of 108 elective orthopedic surgical procedures in hemophilia patients with inhibitors, comprising 88 cases in which radiosynoviorthesis was performed and 20 cases in which major orthopedic procedures were carried out. Hemostatic cover was provided by recombinant factor VIIa (rFVIIa, NovoSeven(R), Novo Nordisk, Bagsvaerd, Denmark) in 17 cases, and by FVIII anti-inhibitor product (FEIBA, Baxter Corp, Toronto, Canada) in the remaining three procedures. A total of 51 patients from nine centers worldwide were included. The results of the procedures were characterized as good (82 procedures), fair (15), or poor (11). Postoperative bleeding complications requiring further surgical intervention occurred in three (15%) of the 20 major orthopedic procedures; all three procedures used rFVIIa as a hemostatic agent. Despite these complications, however, our study has shown that rFVIIa allows hemophilic patients with high inhibitor titers to undergo elective orthopedic surgery (EOS) with a greater expectation of success, leading to an improved quality of life. Thorough analysis of each case as part of a multidisciplinary team will help to identify further inhibitor patients in whom EOS can be performed both safely and effectively.

Blood Coagulation Factor Inhibitors↗
PubMed2004

Internal fixation of nonunions.

We review the two major types of internal fixation of nonunions (plating and intramedullary nailing), and analyze nonunions in different locations (upper and lower extremities). Depending on the type and the location of the nonunion, plating or intramedullary nailing may be selected. Both have advantages and disadvantages: plating requires opening the nonunion site, which entails some damage to the soft tissues, and carries with it a risk of secondary infection. With plating, it often is impossible to do a real decortication because the periosteum may be thin and poorly adherent to bone, and the quality of bone may prove insufficient to achieve good fixation with most of the screws. However, plating still is used in metaphyseal nonunions, and angular deformities may be corrected by applying a plate under tension on the convex side of the bone. Nailing can be done percutaneously in numerous cases; it has a smaller risk of infection but, should an infection be present, there is a risk that it may spread over the entire length of the medullary cavity. Nailing stimulates bone formation, but noninterlocking nails may cause shortening and rotational instability of the nonunion site. Plate fixation was popular approximately 20 years ago, but now has been largely superseded by intramedullary nailing except for proximal or distal nonunions. Dynamic locking nails are preferable. Successful treatment of nonunions often requires several consecutive surgical actions and a global strategy must be established from the beginning, taking care not to interfere with the successive steps.

Arm Injuries↗
PubMed2004

Nonunion: general principles and experimental data.

Nonunions of long bone fractures can be treated successfully with one operative procedure in more than 90% of patients. In fact, 80% of patients can have good to excellent final restoration of mechanical axis alignment and proper length. Patients with infected nonunions may require more than one procedure to eliminate infection and heal the nonunion. Treatment must be tailored to the individual patient to address all components of the problem. We reviewed the main experimental data regarding the knowledge of nonunions and the basic methods that may be applied to the treatment of nonunions.

Animals↗
PubMed2003

[Surgical principles in haemophilia patients].

Close cooperation between hematologists, surgeons, rehabilitation physicians, pediatricians, psychologists, physiotherapists and nurses is essential for the satisfactory result of any orthopedic surgical procedure in persons with hemophilia. There is no doubt that continuous prophylaxis is the way to avoid orthopedic problems of hemophilia that can still be seen today. Until such a goal can be reached, the orthopedic surgeon will continue performing arthrocentheses, synoviortheses, synovectomies, tendon lengthening, debridements, osteotomies, joint replacements, osteosynthesis of fractures and other less frequent surgical procedures to persons with hemophilia. Over the last 30 years some important achievements have been made in the treatment of hemophilia from the orthopedic point of view. However,some others are still to be solved. The common aim of all of them is to improve the quality of life of persons with hemophilia.

Hemarthrosis↗
PubMed2003

Management of musculoskeletal complications of hemophilia.

Prophylactic treatment from ages 2 to 18 years could prevent the development of hemophilic arthropathy if the concentration of the patient's deficient factor is kept from falling below 1% of normal. Early treatment is of paramount importance because the immature skeleton is very sensitive to the complications of hemophilia. Major hemarthrosis and chronic hemophilic synovitis should be treated aggressively to prevent hemophilic arthropathy. When advanced hemophilic arthropathy is present with severe disability, the aim should be to restore function while minimizing the risk to the patient. Joint debridement is an effective method to achieve this goal, especially around the elbow or ankle, and can be considered an alternative to knee replacement in the younger age groups. Proximal tibial valgus osteotomy is a reliable treatment method for painful genu varum of the mobile hemophilic knee. Supramalleolar tibial varus osteotomy is an attractive alternative to the more commonly used surgical option of arthrodesis. Finally, joint replacement can usually be relied on to restore both mobility and function in a diseased joint. The potential benefits of joint replacement must always be weighed against the long-term sequelae, however, especially loosening and consequent revision surgery.

Adolescent↗
PubMed2003

Radionuclide synovectomy (radiosynoviorthesis) in hemophilia: a very efficient and single procedure.

Radionuclide synovectomy, so-called radioactive synoviorthesis, is easy to perform and a not very expensive procedure (for example, 150 US dollars for an adult knee). Moreover, it is very efficient in diminishing the frequency and intensity of recurrent hemarthrosis related to chronic hypertrophic hemophilic synovitis. It should be performed as soon as possible in order to try to halt the long-term damage that intra-articular blood will produce in the involved joint. Personal experience and the general recommendation among orthopedic surgeons and hematologists is that when three early consecutive synoviortheses (repeated every 3 months) fail to halt synovitis, a surgical synovectomy (open or by arthroscopy) should be immediately considered.

Child↗
PubMedDate not supplied

Hemophilic arthropathy.

The most common clinical manifestation of hemophilia is arthropathy secondary to recurrent hemarthroses and chronic synovitis. Joint-surface erosions secondary to chronic synovitis often occur in early childhood and progress to advanced arthropathy by late adolescence. The knee, elbow, ankle, hip, and shoulder are the most commonly involved joints. Management of hemophilic arthropathy has advanced with the development of purified clotting factor concentrates and procedures to prevent chronic synovitis. Radiosynovectomy using beta particle-emitting radiocolloids has been effective in dramatically reducing the frequency of hemarthroses and resolving chronic synovitis. The most common surgical procedures used to manage hemophilic arthropathy are synovectomy, joint debridement, fusion, and joint arthroplasty. Late infection and arthrofibrosis complicate joint arthroplasty more often in these patients than in patients with other forms of arthritis. The high incidence of late infection may relate to frequent intravenous self-infusion of clotting factor combined with immune suppression. Despite the medical and surgical complexities of hemophilic arthropathy, orthopaedic procedures have a high incidence of patient satisfaction.

Autoantibodies↗