Orthopedic Surgery and Traumatology

About the Observatory

Diseases or pathologies of the Musculoskeletal System are those that affect the development and preservation of the form and/or function of the limbs, the spine and associated structures.

The Orthopedic Surgery and Traumatology Service (COT) of the Consorci Sanitari Integral is aimed at providing personalized attention, especially surgery to patients affected by degenerative or traumatic alterations of the locomotor system.

Its healthcare activity is focused on the study, clinical assessment, diagnosis, prevention and treatment of pathologies of the musculoskeletal system of degenerative or traumatic origin. The interest in providing professional quality care is focused on obtaining the best response to the needs of our population, thus obtaining a high rate of satisfaction perceived by our patients affected by pathologies of the musculoskeletal system of the limbs and spine.

The Service also carries out continuous training for its members to be able to offer up-to-date and quality assistance to the population. Quality control is common by carrying out general and specific clinical sessions to assess the patients treated and the results obtained.

It has a direct relationship with the Rheumatology Services, Pain Clinic Unit and Rehabilitation, all being framed within the Locomotor System Area

  • Update date: 01.01.2024

Assistance activity

The COT service offers specialized assistance in:

  • Sant Joan Despí Moisès Broggi Hospital.
  • L'Hospitalet General Hospital.
  • Specialized Assistance Centers (CAE) Torrassa, Cornellà and Sant Feliu.
Type of activity
  1. Emergencies
  2.  Hospitalization
  • Types of Income:
    • Scheduled or conventional: Surgical or non-surgical patient admitted for elective surgery or who needs admission for study.
    • urgent: Surgical or non-surgical patient admitted through the emergency room.
    • Fast Track: Admission for elective hip or knee prosthetic surgery, with characteristics similar to the usual admission with an estimated stay of between three and four days.
    • CMA (Ambulatory Major Surgery): The patient spends a few hours in the Hospital and then returns to his home or residence without admission. The clinical or surgical procedure is less traumatic than that which requires a regular admission and the characteristics of the patient allow it. Admission to the hospital is through the walk-in surgery unit (UCSI). Examples: median nerve release, tendon sheath release, spring fingers, De Quervain, ganglion excision, benign soft tissue tumors, removal of osteosynthesis material, minor bone surgery, minor osteosynthesis, epicondylitis surgery, arthroscopies knee, hallux valgus, hammer toes, etc.
    • Hospitalization at home: The patient is admitted to his home and it is the hospital staff (doctor, nurse, physiotherapist, etc.) who travel to the patient's home.
    • Operating theatres: Emergency and scheduled surgery.
    • See our menu face-to-face outpatient clinic and Hospital telematics, distributed by Units.
    • See our menu face-to-face and online Specialized Care (CAE) outpatient clinic:
      • Ronda la Torrassa
      • Cornellà de Llobregat
      • Sant Feliu de Llobregat

Head of Service

  • Jose Miguel Sales Perez

    orthopedic surgery hsjd

    healthcare coordinator doctor

Head Clinic

Members
  • Natalia Llorens Vilafranca

    orthopedic surgery hsjd

    specialist doctor

  • Maria Josefa Muñoz Arnedo

    orthopedic surgery hsjd

    area coordinator doctor

  • Nuria Redon Montojo

    orthopedic surgery hsjd

    specialist doctor

  • Rafael Reina Santos

    orthopedic surgery hgh

    specialist doctor

  • Luis Lazaro Saz Delort

    orthopedic surgery hsjd

    specialist doctor

  • Vanesa Vega Ocaña

    orthopedic surgery hsjd

    specialist doctor

  • Ariadna Caparros Garcia

    orthopedic surgery hsjd

    specialist doctor

  • Vanessa Adamuz Medina

    orthopedic surgery hgh

    specialist doctor

  • Albert Gonzalez Navarro

    orthopedic surgery hgh

    specialist doctor

  • Alejandro Poal Manresa Cantarell

    orthopedic surgery hsjd

    specialist doctor

  • Xavier Bial Vellve

    orthopedic surgery hgh

    service coordinator doctor

  • Carlos Solano Puerta

    orthopedic surgery hgh

    healthcare coordinator doctor

  • Carlos Xavier Rojas Cuotto

    orthopedic surgery

    specialist doctor

  • Jorge Roman Verdasco

    orthopedic surgery hsjd

    specialist doctor

  • Nuria Boo We like it

    orthopedic surgery hsjd

    specialist doctor

  • Alejandro Santamaria Fumas

    orthopedic surgery hgh

    specialist doctor

  • Miquel Angel Videla Ces

    orthopedic surgery hsjd

    service coordinator doctor

  • Ana Maria Lopez De la Fuente

    hsjd teaching

    executive secretary

  • Eudald Romero Pijoan

    orthopedic surgery hsjd

    service coordinator doctor

  • Amaia Endemaño Lucio

    orthopedic surgery residents

    resident doctor

  • Anna Maudos Segarra

    orthopedic surgery residents

    resident doctor

  • Mouin Kanj Raad

    orthopedic surgery hsjd

    specialist doctor

  • Ramon Ortin Oliete

    orthopedic surgery hsjd

    specialist doctor

In this section appear the professionals of the Integral Health Consortium who have authorized the display of their personal data.

  • Update date: 01.01.2024

Units and benefits

The service is integrated by different highly specialized Units to improve assistance. The close collaboration between the units provides added value in the comprehensive care of the patients who are treated. This collaboration is extended to other specialties in case the patient requires it, either through cross-disciplinary multidisciplinary units such as orthogeriatrics or the Unit of Septic Pathology of the Locomotor System (UPSAL) or through interconsultations punctual

There are common treatments in different units, with joint coordination for their appropriate application, such as infiltrations with plasma rich in platelets (growth factors) or viscosupplementation. The COT service collaborates with the hematology service by applying blood-saving protocols, especially in those procedures that may require transfusion, which results in less morbidity and better clinical results.

Upper Extremity Unit

It takes care of shoulder, elbow, wrist and hand pathologies.

  • Intra- and extra-articular pathology of the shoulder. Arthroscopic and open repair techniques for tendinous involvement of the rotator cuff, shoulder joint instability and joint stiffness among other pathologies.
  • Surgery of fractures and dislocations of the upper limb. Osteosynthesis and arthroplasties.
  • Surgery for the sequelae of fractures (osteotomies and arthroplasties).
  • Degenerative arthrosis and inflammatory pathology. Joint prostheses.
  • Revision surgery for prosthetic replacements and periprosthetic fractures.
  • Traumatic and degenerative elbow surgery. Osteosynthesis and arthroplasties.
  • Elbow instability: surgery for acute and chronic instabilities.
  • Muscle injuries. Surgery for epicondylitis and epitrochleitis.
  • Elbow stiffness: arthrolysis.
  • Traumatic and degenerative wrist and hand surgery. De Dupuytren's disease, tendon injuries, rhizarthrosis.
  • Treatment of infections.
  • Peripheral nerve compression release surgery. Carpal tunnel syndrome, ulnar algoparesis, etc.
  • Soft tissue surgery. Synovial cysts, tendinopathies, synovectomies, etc.
  • Osteotomies for correction of deformities.
  • Pseudoarthrosis surgery
  • Arthrodesis and arthroplasties of the wrist joints of the hand
  • Wrist instability and pathology of the distal radioulnar joint.
  • infiltrations
  • Treatment with 3D guides for glenoid defects in total shoulder prostheses.
  • Treatment of pseudarthrosis with vascularized bone graft microsurgery.
Vertebral Column Unit (rachis)

It is responsible for the care of degenerative and traumatic pathologies of the spine.

  • Lumbar disc herniation
  • Lumbar disc degeneration
  • Lumbar spinal canal stenosis
  • Instability (traumatic or degenerative)
  • Spondylolisthesis
  • Fractures of the lumbar spine or thoracolumbar joint
  • Depending on each pathology, different surgical techniques are performed to decompress and stabilize the affected spinal segments:
    • discectomy
    • Spinal canal decompression
    • Posterolateral arthrodesis (fixation with pedicle screws and provision of bone grafts) and in some cases with interbody arthrodesis (PLIF, TLIF).
Hip Surgery Unit

It deals with the diagnosis and treatment of pathologies affecting the hip joint (femoral lameness).

  • Uncemented, hybrid or cemented total hip arthroplasty for the treatment of coxarthrosis or joint degeneration due to inflammatory arthritis.
  • Perforations or arthroplasty to treat avascular necrosis of the femoral head.
  • Arthroplasty to treat sequelae of hip dysplasia.
  • Prosthetic revision surgery of high complexity of hip in 1 or 2 times for loosening or infection.
  • Open and arthroscopic hip surgery for femoroacetabular impingement and labrum injuries.
  • Treatment of hip, pelvis and acetabulum fractures.
  • Infiltrations, aspirations and joint drainage.
Knee Surgery Unit

It deals with the diagnosis and treatment of pathologies affecting the knee joint.

  • Osteoarthritis surgery: femoral and tibial osteotomies, total knee replacement, unicompartmental prostheses.
  • Prosthetic surgery with personalized guides.
  • Prosthetic surgery with Augmented Reality.
  • Prosthetic surgery with Navigation.
  • Distal femoral and proximal tibial osteotomies with customized guides.
  • Osteochondral lesions (articular cartilage): mosaicoplasty, microfractures, acellular collagen implant.
  • Ambulatory arthroscopic surgery: meniscal repair (meniscal suture), partial meniscectomy, joint cleaning free bodies, ligamentous reconstruction of ACL, LCP and acute and chronic lateral ligaments. Extraarticular plastics.
  • Pathology of the patella: instability of the patella and recurrent dislocation of the patella. External patellar hyperpressure syndrome
  • Traumatology: multiligamentary injury, knee dislocations.
  • Extra-articular deformities. Axial alterations of the axes of the lower limbs. Genu Valc. Genu Varus
  • Aseptic prosthetic revision surgery.
  • Revision prostheses and tumor patella.
Ankle and Foot Surgery Unit

The Ankle and Foot Unit assesses and treats degenerative and/or traumatic pathologies that affect this anatomical location. He routinely uses open and minimally invasive (percutaneous) surgery, personalizing the treatment according to the pathology and needs of each patient. One of the important activities is the collaboration with the Multidisciplinary Diabetic Foot Unit and the surgical treatment of Charcot's foot of great significance due to its high social and economic cost and with a significant decrease in the quality of life of these patients .

Foot and ankle traumatic pathology surgery and sequelae.

Forefoot surgery:

  • Hallux valgus
  • Hallux rigidus
  • 5th varus ("tailor's wheel")
  • Small finger deformities (hammer fingers...)
  • Metatarsalgias
  • Release of peripheral neurological compressions: Morton's neuroma, etc.

Midfoot surgery:

  • Mid-tarsal arthrosis
  • Release of peripheral neurological compressions

Hindfoot surgery:

  • Flat foot equal to the adult
  • hollow foot
  • Ankle arthrosis
  • Subtalar arthrosis
  • Tarsal tunnel syndrome.
  • Ankle instability
  • Chronic tendinopathies: Pathology of the peroneal tendons, Achilles tendon, gastrocnemius release etc.
  • Osteochondral lesions of talus.

Ankle surgery:

  • arthroscopy
  • Total ankle arthroplasty
  • arthrodesis
  • Osteotomies
  • Acute / chronic ligament injuries.

Articular and peritendinous infiltrations

  • Growth factors
  • Hyaluronic acid
  • Corticosteroids

Diabetic foot surgery (deformities, Charcot foot, etc.).

  • Preventive surgeries with bone and tendinous corrections
  • Complex reconstructions for Charcot neuroarthropathy
  • Debridement and treatment of diabetic foot ulcers

 

Traumatology and Orthogeriatrics Unit

The Traumatology unit is in charge of the diagnosis, treatment and follow-up of fractures and dislocations in an urgent or deferred manner on an ongoing basis. This treatment can be surgical or conservative (plaster, orthosis, etc.). The main fractures of long bones (humerus, ulna and radius, hand, femur, tibia and fibula, foot, pelvis and acetabulum) and the increasingly frequent fractures that occur in the vicinity of bones bearing previous implants (periprosthetic fractures). Gives care to polytraumatized patients.

If necessary, they carry out joint treatment with plastic surgery practitioners for the skin coverage of those open lesions that require it. The unit has high experience in the provision of bone grafts for the treatment of fractures and pseudarthrosis.

For the treatment of these injured patients, different techniques and implants are used, customized to the patient and their injury. Minimally invasive procedures are used in the treatment of many fractures, being for this reason a leading unit at state level.

The Orthogeriatrics unit is a multidisciplinary unit that coordinates doctors from the following services: Orthopedic Surgery and Traumatology, Internal Medicine and Geriatrics, Nursing, Social Work and Rehabilitation and Physiotherapy. The aim of the unit is the comprehensive management in the pre- and post-operative period of patients over 75 years of age, affected by fractures due to fragility of the femur or related complications. These patients, due to their characteristics, present great fragility and medico-social complexity and therefore require optimal and urgent optimization and stabilization (which in most cases includes a surgical intervention) in order to recover the functionality prior to the fracture as soon as possible, and try to avoid complications associated with functional decline and immobilization, as well as correct pain management. The multidisciplinary approach to these patients is essential to achieve all these objectives.

Osteoarticular infection unit:

This unit is responsible for the diagnosis, treatment and follow-up of all infections affecting the locomotor system. Given that these are very complex and potentially serious pathologies that do not only require the approach of TOC, the unit is part of a larger multidisciplinary unit (Septic Pathology Unit of the Locomotor System) integrated by other specialties such as microbiology, internal medicine, infectious diseases, nursing, plastic surgery...etc. This allows, in accordance with the values ​​of our institution, to put the patient at the center of the care process and offer him a comprehensive and personalized approach.

Although there is a wide range of infectious pathologies of the locomotor system, the main ones that the unit responds to are:

  • Acute prosthetic infection (API) – treatment of choice Debridement with mobile component replacement (DAIR)
  • Chronic prosthetic infection (IPC) – treatment of choice replacement in 1 stage (R1T) or replacement in two stages (R2T).
  • Chronic osteomyelitis – radical debridement + reconstruction (this second point is sometimes carried out together with the plastic surgery service).
  • Acute infection associated with fractures – debridement +/- fixation replacement
  • Septic pseudoarthrosis - radical debridement + fixation.
  • Septic arthritis in native joint – debridement.
  • Abscess or soft tissue infection – debridement
  • Necrotizing fasciitis – debridement, fasciotomy and in extreme cases amputation
  • Update date: 01.01.2024

Diseases and procedures

  • Osteoarthritis:

    Degenerative disease of the articular cartilage that causes pain and inflammation of the joints causing limitations in function and in daily life. Its treatment is aimed at improving function and the disappearance or improvement of pain. The best treatment is prevention, but in already established cases a personalized treatment must be given to the patient and the affected joint. Depending on the functional need, the age of the patient and the degree of joint wear and tear, the treatment is aimed at correcting the factors that cause the alteration and preserving its non-painful function by delaying the pathological evolution, up to prosthetic replacement adapting the different implant models and materials to achieve the best results.

  • Joint prosthesis:

    Replacement of the affected joint surfaces by an artificial implant that performs the function of movement and support of the joint with improvement or elimination of the pain caused by the joint disease.

  • Revision or replacement of a joint prosthesis:

    Surgery to replace an existing prosthesis that has reached the end of its useful life due to mechanical loosening or infection. It is a highly complex surgery.

  • Infiltration:

    Procedure by which, by means of an injection, a pharmacological substance is administered locally or obtained from the patient himself, to improve the pathology and pain caused by a disease. The infiltrations can have an anti-inflammatory, regenerative and/or supplemental effect. Commonly used are infiltrations with plasma rich in platelets, obtained by extracting and manipulating the patient's own blood, and viscosupplementation infiltrations with hyaluronic acid.

     

  • Osteosynthesis implant:

    Element used to stabilize a fracture after its reduction and prevent displacement until the bone heals.

  • Update date: 01.01.2024

Research

Despite having a high care burden, research must be and is one of the pillars of the COT Service. This is why the Service develops research studies in different areas of the specialty, studies that are initially presented in courses and congresses to later be published in different national and international medical journals of the specialty. It is this clinical research that allows the service to evaluate the results obtained in daily activity and then implement measures to continuously improve the quality of care.

Within the Service, there are three units that stand out today for their scientific activity: the UTO, the foot and ankle unit and the osteoarticular infection unit.

The service maintains a continuous line of research in the treatment of peri-prosthetic and peri-implant fractures (fractures that occur in the vicinity of a previous implant) which are increasingly frequent and require a high degree of specialization for their treatment. Advanced and up-to-date biomechanical and biological concepts are used to personalize your treatment, being a leading and recognized center in Europe (AOTrauma Europe).

The Service is also involved in the development of new computerized technologies such as 3D printing.

  • Update date: 01.01.2024

Teaching

Training of specialists via MIR in Orthopedic Surgery and Traumatology. MIR residents are also trained in the specialty of other Hospitals who regularly rotate through our service. Resident tutors, V. Vega and A. Manent. Teaching Collaborators, M. Velasco, A. Dominguez, M. Lalanza, R. Rivero, V. Maldonado, V. Adamuz, A. López, J. Vilanova, V. Ros, N. Boo and E. Romero.

Training of specialists in Family and Community Medicine who rotate through our service.

The COT Service has as Teaching Objectives those proposed by the Teaching Committee annually, agreed upon and approved by the Management Committee.

Postgraduate training for specialists who come to our service to complete their training.

Undergraduate training for medical students University of Barcelona. Coordination Dr. J. Miquel Sales, Associate Professor of the Faculty of Medicine and Health Sciences of the University of Barcelona (Clinical Campus). Teaching Collaborators as Clinical Professors University of Barcelona in Teaching the Degree in Medicine M. Videla, R. Sanchez, V. Vega, J. Álvarez and Ll. source Finally, they are also teaching collaborators in undergraduate training: G. Molina, X. Bial, R. Torrents and MJ Muñoz.

Participation in continuing education programs in primary care, with the creation of patient referral protocols agreed with the family doctors of the outpatient clinics corresponding to the area.

Masters

Face-to-face Master in Foot and Ankle Pathology and Surgery. UIC (Faculty of Medicine and Health Sciences) CSI (Integral Health Consortium).

With a duration of 1 year and 2-3 places.

Courses

Each year, different courses are organized directly by the Service or in direct collaboration with its members in the pathologies of the specialty. Active participation in Courses and Congresses as well as stays in other centers is carried out.

 

Publications

The publication of the works carried out in specialized magazines is a complementary activity to the assistance tasks. The publication of books and the collaboration in various multidisciplinary and multicentric works also help in the subsequent redundant updating of the quality of care provided to our patients. This year 2023 different members of the Service have participated in 14 articles and/or book chapters.

  • Update date: 01.01.2024