Villas-Tome, C. (Carlos)
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- Stress fracture of the fifth metatarsal in foot deformity secondary to neuromuscular disease: experiences of deformity correction treatment-a report of 3 cases and review of the literature(2018) Elorriaga-Sagarduy, G. (Gotzon); Payo-Ollero, J. (Jesús); Alfonso-Olmos-García, M. (Matías); Ruiz-Nasarre, A. (Alberto); Alvarez-Goenaga, F. (Fernando); Villas-Tome, C. (Carlos)Fractures at the proximal metaphyso-diaphyseal junction of the fifth metatarsal are associated with high rates of delayed union. When these fractures are the result of repeated stress in patients with equinovarus hindfoot, which in turn is caused by neurological disorders, delayed union is the rule. Therefore, in neurological patients with stress fractures, optimal treatment would be to achieve a plantigrade foot enabling them to relieve the fifth metatarsal overload, which prevents the consolidation. We report 3 cases of fifth metatarsal stress fracture resulting from an equinovarus hindfoot deformity caused by a neuromuscular disease. Our surgical indication was to correct the foot deformity with no direct action on the fracture. Once a good alignment (plantigrade foot) was obtained, stress causing the fracture disappeared, and union was achieved with optimal biomechanical function in all 3 fractures. When stress fracture of the fifth metatarsal is caused by a secondary foot deformity, treating the deformity can lead to healing the fracture efficiently and should be considered prior to indicating surgical stabilization of the fracture itself. Primary treatment of the fracture with no correction of the deformity leads to therapeutic failure. Levels of evidence: Therapeutic, Level IV.
- Sinostosis congénitas del tarso: concepto, clasificación, diagnóstico y planteamiento terapéutico(Universidad de Navarra, 2001) Garcia-Barrecheguren, E. (E.); Beguiristain-Gurpide, J.L. (José Luis); Barriga, A. (Andrés); Barroso, J.L. (José L.); Villas-Tome, C. (Carlos)incidencia de las sinostosis congénitas del tarso se estima en torno al 1% de la población, siendo una de las causas más comunes de pie plano rígido doloroso en la población pediátrica. La barra calcáneoescafoidea (50%) y el puente astragalocalcá¬neo (40%) son las formas de presentación más frecuentes. La restricción de la movilidad, el dolor mecánico en el lugar de la fusión y la deformidad del calzado referida en la anamnesis deben hacernos sospechar esta entidad. En la exploración física destaca la rigidez del retropié con limitación dolorosa característica de la pronosupinación que ha motivado clásicamente la errónea denominación de pie plano peroneo espástico. El diagnóstico radiológico se hace normalmente con radiografías simples (proyecciones laterales y oblicuas entre 35 y 45º), en las que observamos el osteofito anterior de la cabeza del astrágalo o la imagen de condensación en "media luna" del astrágalo superpuesto con el calcáneo, siendo necesario en ocasiones recurrir al TAC. Entre las posibilidades terapéuticas, el tratamiento quirúr¬gico es el único resolutivo del problema de base. La resección-artroplastia de interposición debe intentarse en pacientes jóvenes en los que se quiera preservar la biomecánica normal del pie, evitándose los problemas a largo plazo de la artrodesis. La triple artrodesis o la artrodesis subastragalina, se reservan para pacientes mayores con signos degenerativos, en casos de fusio¬nes tarsianas múltiples y tras fracaso de la resección¬-artroplastia
- Quiste sinovial en articulación interapofisaria lumbar. Una causa infrecuente de lumbociática(Universidad de Navarra, 1997) Leyes, M. (Manuel); Villas-Tome, C. (Carlos)Los quistes sinoviales de las articulaciones facetarias pueden ser asintomáticos o provocar dolor lumbar, con o sin clínica radicular. Se considera que son secundarios a traumatismos o a degeneración articular, y ocurren con mayor frecuencia en pacientes con espondi lolistesis. El diagnóstico se establece con la tomografía axial computarizada o la resonancia magnética, que mues tran una lesión quísti ca adyacente a la faceta articu lar. Realizamos una revis ión de la literatura y presenta mos un paciente con radiculopatí a S1 izquierda cau sada por un quiste sinovial de la articulación facetaria L5 - S1. El tratamiento fue curativo y consistió en la resección del quiste.
- Lumbosacral arthrodesis using pedicular screws and ringed rods(Springer Verlag, 1997) Beguiristain-Gurpide, J.L. (José Luis); Preite, R. (Ricardo); Martinez, R. (R.); Barrios, R.H. (Raúl H.); Villas-Tome, C. (Carlos)Sixty-one patients who had lumbar instability and chronic low back pain or deformity from nontraumatic lumbar pathologies were studied. In all of them a posterior lumbosacral fusion with CUN (Clinic of the University of Navarre) pedicle rod fixation was used. The mean follow-up period was 36 months (range 26-46 months). The consolidation rate was evaluated according to plain and functional radiographs, and a clinical evaluation was made using an analogue pain scale. The rate of fusion was 93.5%. Neurological complications occurred in 3.3%. The incidence of screw failure was 2.3% of all the screws. No other implant failure occurred. The patients rated their clinical results as 'excellent' in 33.8% of the cases, 'good' in 42.2%, 'fair' in 16.9% and 'poor' in 6.7%. CUN instrumentation is a versatile internal fixation system that has been shown to provide satisfactory stability. Furthermore, the clinical results are comparable to those reported in studies in which the most common hardwares were used.
- Eosinophilic Granuloma of the Spine With and Without Vertebra Plana: Long-term Follow-up of Six Cases (Cast Reports)(Ovid, 1993) Martinez-Peric, R. (Rodrigo); Beguiristain-Gurpide, J.L. (José Luis); Barrios, R.H. (Raúl H.); Villas-Tome, C. (Carlos)Vertebral eosinophilic granuloma is a rare condition frequently associated with vertebra plana. In this paper we present six patients with eosinophilic granuloma of the spine; three were without vertebra plana, which represents a diagnostic problem. The mean follow-up was 9 years, (range 2 to 23) and the mean age was 10.8 years at diagnosis. All complained of pain with no neurological deficit. The lesions were located on the vertebral bodies of C4, T9, T10, L1, L2, and L5, respectively. Histologic confirmation of diagnosis was obtained in all patients, two by puncture and four by open biopsy. The patients with vertebra plana (T10, L1, and L5, respectively) were treated conservatively. Long-term follow-up demonstrated total healing of the vertebral body in two and partial rebuilding 8 years after diagnosis in one. Patients without vertebra plana (C4, T9, and L2, respectively) underwent curettage and bone grafting. In the patient with T9 location, a T8-10 anterior arthrodesis with autogenous rib graft was performed. The outcome was satisfactory in all.
- Osteoid osteoma in the ankle and foot. An overview of 50 years of experience(Elsevier, 2021) San-Julian, M. (Mikel); Payo-Ollero, J. (Jesús); Moreno-Figaredo, V. (Victoria); Alfonso-Olmos-García, M. (Matías); Llombart-Blanco, R. (Rafael); Villas-Tome, C. (Carlos)Background: The literature published about osteoid osteoma (OO) in the ankle-foot consists mainly on case reports. Methods: We performed a retrospective study in which we analyzed demographic parameters, pain characteristics, treatment options and functional outcomes measured using the AOFAS and the SEFAS scales. Results: We treated 17 patients with OO around the ankle-foot. Eighty-eight percent of patients had night pain that was relieved with NSAIDs. The bones most often affected were the talus and calcaneus. OO was diagnosed 21 months after the onset of symptoms. Mean follow-up was 17.3 years. The surgical techniques most used were curettage and curettage and bone grafting. There was a significant increase in AOFAS and SEFAS scores after surgery. Conclusions: Suspicion is the base of a prompt and a correct diagnosis of OO. The OO should be especially suspected in patients who present night pain that can be relieved with NSAIDs.
- A Comparative Ultrastructural Study of Chondrosarcoma, Chordoid Sarcoma, and Chordoma(Wiley-Blackwell, 1981) Guillen, F.J. (F. J.); Pardo-Mindan, F.J. (Francisco Javier); Vazquez, J.J. (Jesús Jaime); Villas-Tome, C. (Carlos)A morphologic and electron microscopic study was made of two chordoid sarcomas. These lesions were compared with two classical chondrosarcomas and two chordomas. These chondrosarcoma cells showed many features common to chondrocytes, such as abundant RER, well-developed Golgi complexes, and microvillous cytoplasmatic membranes. The chordoid sarcomas bore a close morphologic resemblance to the chordomas but the ultrastructural features revealed a close relationship to the chondrosarcomas. The chordoid sarcoma and chondrosarcoma cells had scalloped cytoplasmatic membranes, variable amounts of glycogen, round or oval nuclei and microfibrils, collagen, and electron-dense granules in the ground substance. The chordoma was characterized by the presence of stellate and physalipherous cells, as well as many transitional cells, with varying nuclear morphology; dilated and irregular RER in contact with mitochondria and morphologically varied vacuoles are the main features in the cytoplasm. This study suggests that chordoid sarcoma represents a variety of the chondrosarcoma rather than a form of chordoma. These findings also support the suggestion of Weiss that chordoid sarcoma is an extraskeletal myxoid chondrosarcoma
- Infected Vertebroplasty Due to Uncommon Bacteria Solved Surgically: A Rare and Threatening Life Complication of a Common Procedure(Lippincott, Williams & Wilkins, 2006) Duart-Clemente, J. (Julio); Alfonso-Olmos-García, M. (Matías); Silva, Á. (Álvaro) de; Villas-Tome, C. (Carlos)Case report. OBJECTIVE: The aim of this work is to describe a case of infected vertebroplasty due to uncommon bacteria solved surgically with 2 years of follow-up and to discuss 6 other cases found in literature. SUMMARY OF BACKGROUND DATA: Vertebroplasty is a well-known and useful technique for the treatment of painful osteoporotic vertebral fractures. Complications, such as cord or root compression or pulmonary embolisms, are infrequent and are mainly related with the frequent escape of cement throughout the vertebral veins. Infection is even more rare, but when it occurs is difficult to manage and can be a life-threatening complication. METHODS: A 63-year-old-man had a spondylitis of L2 after vertebroplasty. The patient was initially managed with antibiotics without clinical improvement. Surgical treatment by anterior debridement and anterior and posterior stabilization was done. The bacteria isolated from the intraoperative cultures were Serratia marcescens, Stenotrophomonas maltophilia, and Burkholderia cepacia. After surgery, the patient was treated with antibiotics for 3 month. RESULTS: After 2 years of follow-up, the patient was free of pain, without signs of infection, and a correct fusion was achieved. CONCLUSION: When facing an infected vertebroplasty, initial conservative treatment with needle biopsy culture and antibiotic administration are a rational option to start. If this treatment fails, surgical debridement is then indicated in order to remove the infected tissue and the acrylic cement and to stabilize the spine. Although this can be an effective treatment, it could be a difficult and hazardous surgical procedure.
- Pure cervical radiculopathy due to spontaneous spinal epidural haematoma (SSEH): report of a case solved conservatively(Springer, 2006) Alfonso-Olmos-García, M. (Matías); Silva, Á. (Álvaro) de; Villas-Tome, C. (Carlos)Abstract Introduction: Spontaneous spinal epidural haematoma (SSEH) is widely recognised throughout the literature as a cause of myelopathy, radicular compression being very rarely reported. Surgical management is almost always recommended, especially in the cases of spinal cord compression. Conservative treatment is reported as a curiosity and only in the case of spontaneous improvement. This report presents the particular case of a 64-year-old patient undergoing anticoagulant therapy that had a cervical radiculopathy due to a SSEH confirmed by MRI. The patient improved spontaneously and symptoms were solved with unconventional conservative treatment and without stopping the anticoagulant therapy. Conclusions: Spontaneous epidural haematoma must be kept in mind when patients undergoing anticoagulant therapy have a sudden onset of cervicobrachialgia. Even though most spinal surgeons advocate surgical treatment, a conservative approach may lead to a complete recovery and may be considered as a good option in the case of radicular involvement. Discontinuation of the anticoagulant therapy may not always be needed, especially when the clinical syndrome improves spontaneously.
- Influencia de la edad en el resultado de la cirugía sustitutiva total de la cadera(Universidad de Navarra, 1983) Cañadell, J.M. (J. M.); Arenas, A. (A.); Imizcoz, J.L. (J. L.); Villas-Tome, C. (Carlos); Valenti-Nin, J.R. (Juan Ramón)A revision of the first 700 total hip prostheses (operated on in the period 1969-1980) is carried out with the purpose to establish the influence of the age on the evolution of the arthroplasty. The results are very satisfactory but it is younger patients that complications related to loosening are more frequent. This fact can be explained by a longer period of evolution and a major prosthetic stress in these patients. By this reason, we do not use actually cement to fix the implants in those patients younger than sixty.