Eva Guisasola Lerma, Francisco Javier Lucas García, Alberto Márquez Caraballo, David Santosjuanes Royo
Abstract Injuries to the triangular fibrocartilage complex (TFCC) can lead to instability of the distal radioulnar joint (DRUJ). In fact, they are the most frequent cause of it. But, in other cases, depending on the type of injury, the DRUJ remains stable. This will condition different types of treatments, from conservative management to the different options of surgical treatment. Since a controversy persists regarding the management of these lesions, our purpose is to disclose the foundations of the rehabilitation treatment and propose an algorithm of treatment according to the different types of injuries and their repairs. Resumen Las lesiones del complejo del fibrocartílago triangular (CFCT) pueden provocar una inestabilidad de la articulación radiocubital distal (ARCD). De hecho, son la causa más frecuente de ésta. Pero, en otras ocasiones, según el tipo de lesión, la ARCD se mantiene estable. Esto va a condicionar distintos tipos de tratamientos, desde el conservador hasta distintas opciones de intervenciones quirúrgicas. Dado que persiste la controversia en cuanto al manejo de estas lesiones, nuestro propósito es exponer las bases del tratamiento rehabilitador y proponer un algoritmo de tratamiento según los distintos tipos de lesiones y sus reparaciones.
{"title":"Rehabilitation in Triangular Fibrocartilage Complex Injuries: Treatment Algorithm","authors":"Eva Guisasola Lerma, Francisco Javier Lucas García, Alberto Márquez Caraballo, David Santosjuanes Royo","doi":"10.1055/s-0042-1748854","DOIUrl":"https://doi.org/10.1055/s-0042-1748854","url":null,"abstract":"Abstract Injuries to the triangular fibrocartilage complex (TFCC) can lead to instability of the distal radioulnar joint (DRUJ). In fact, they are the most frequent cause of it. But, in other cases, depending on the type of injury, the DRUJ remains stable. This will condition different types of treatments, from conservative management to the different options of surgical treatment. Since a controversy persists regarding the management of these lesions, our purpose is to disclose the foundations of the rehabilitation treatment and propose an algorithm of treatment according to the different types of injuries and their repairs. Resumen Las lesiones del complejo del fibrocartílago triangular (CFCT) pueden provocar una inestabilidad de la articulación radiocubital distal (ARCD). De hecho, son la causa más frecuente de ésta. Pero, en otras ocasiones, según el tipo de lesión, la ARCD se mantiene estable. Esto va a condicionar distintos tipos de tratamientos, desde el conservador hasta distintas opciones de intervenciones quirúrgicas. Dado que persiste la controversia en cuanto al manejo de estas lesiones, nuestro propósito es exponer las bases del tratamiento rehabilitador y proponer un algoritmo de tratamiento según los distintos tipos de lesiones y sus reparaciones.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e49 - e59"},"PeriodicalIF":0.0,"publicationDate":"2022-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45011441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Ribau, Elisabete Ribeiro, Cecília Barros, Juvenália Ribeiro, Pedro Varanda, L. Rodrigues
Abstract Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern. Purpose To address the influence of dorsal capsulodesis in postoperative results. Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC). Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%). Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate. Level of Evidence Level III (Retrospective Comparative Study). Resumen Antecedentes Los ganglios dorsales de la muñeca son el tumor de tejidos blandos más común en el miembro superior. El manejo con resección artroscópica proporciona buenos resultados y pocas complicaciones, pero la recurrencia sigue siendo motivo de preocupación. Objetivo Comprender la influencia de la capsulodesis dorsal en los resultados postoperatorios. Pacientes y métodos Se evaluaron dos grupos con ocho pacientes cada uno: el grupo A, de resección artroscópica simple (RAS), y el grupo B, de resección artroscópica combinada con capsulodesis dorsal (RACD). Resultados La edad media del grupo A fue de 36,10 ± 7,96 (rango: 28–53) años, y la del grupo B fue de 34,17 ± 29,60 (rango: 18–44) años. El período de seguimiento fue de 30,67 ± 13,90 (rango: 13,45–53,55) meses y 29,60 ± 16,80 (rango: 12,68–62,13) meses, respectivamente. Para ambos grupos, se logró una disminución significativa en la escala visual analógica (EVA) posoperatoria (alrededor de 2/10), y los valores del cuestionario de Discapacidades del Brazo, Hombro y Mano ( Disabilities of the Arm, Shoulder and Hand , DASH, en inglés) estuvieron por debajo de 5/100. Todos los parámetros funcionales (rango de movimiento y fuerza) estuvieron por encima del 80% del lado contralateral, sin diferencias entre grupos. Más del 75% de los pacientes quedaron completamente satisfechos. Hubo una diferencia estadísticamente significativa para la tasa de recurrencia entre
摘要背景腕背神经节是上肢最常见的软组织肿瘤。关节镜切除治疗效果良好，并发症少，但复发仍然是一个问题。目的探讨背囊术对术后效果的影响。患者和方法分为两组，每组8例:A组-单纯关节镜切除(SAR)， B组-关节镜切除联合背囊固定术(ARDC)。结果A组患者平均年龄36.10±7.96岁(范围28 ~ 53岁)，B组患者平均年龄34.17±29.60岁(范围18 ~ 44岁)。随访时间分别为30.67±13.90(13.45 ~ 53.55)个月和29.60±16.80(12.68 ~ 62.13)个月。两组术后视觉模拟量表(VAS)评分均显著下降(约为2/10)，手臂、肩和手残疾问卷(DASH)评分均低于5/100。对侧各项功能参数(活动度、力量)均在80%以上，组间无差异。超过75%的患者完全满意。A组复发率(37.5%)明显高于B组(12.5%)。结论SAR与ARDC具有良好的临床效果，无显著性差异。背部包膜切除术对降低复发率有重要作用。证据等级III级(回顾性比较研究)。续前文:神经节背侧发育发育muñeca肿瘤背侧发育发育发育发育más comúnEl manejo con resección artroscópica按并发症的比例计算，pero la recurcia sigue siendo motivation de preocupación。目的探讨对术后背囊切除效果的影响。对两组患者分别采用A组、resección artroscópica单纯组(RAS)、B组、resección artroscópica联合包膜脱背组(RACD)。结果A组与B组分别为36,10±7,96(实验结果:28-53)años和34,17±29,60(实验结果:18-44)años。El período de seguimiento fue分别为30,67±13,90 (rango: 13,45 - 53,55)组和29,60±16,80 (rango: 12,68 - 62,13)组。Para ambos组，see logró una disminución显著视力障碍analógica (EVA)手术后(2/10)，los valores del Discapacidades del Brazo, Hombro y Mano(手臂、肩膀和手的残疾，DASH, en ingl)， estuvieron por debajo de 5/100。Todos los parámetros functiononales (rango de movimiento y fuerza)在不同的中心组中，有80%的对侧缺陷。Más为75%的患者提供了完整的满意度。A组(37.5%)与B组(12.5%)的复发率有显著性差异(estadísticamente)。结论En conclusión, RAS与RACD的比值与结果clínicos差异有统计学意义。背囊脱膜术是一种治疗复发性肿瘤的重要方法。Nivel证据Nivel III (Estudio comparative Restrospectivo)。
{"title":"Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study","authors":"M. Ribau, Elisabete Ribeiro, Cecília Barros, Juvenália Ribeiro, Pedro Varanda, L. Rodrigues","doi":"10.1055/s-0042-1748852","DOIUrl":"https://doi.org/10.1055/s-0042-1748852","url":null,"abstract":"Abstract Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern. Purpose To address the influence of dorsal capsulodesis in postoperative results. Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC). Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%). Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate. Level of Evidence Level III (Retrospective Comparative Study). Resumen Antecedentes Los ganglios dorsales de la muñeca son el tumor de tejidos blandos más común en el miembro superior. El manejo con resección artroscópica proporciona buenos resultados y pocas complicaciones, pero la recurrencia sigue siendo motivo de preocupación. Objetivo Comprender la influencia de la capsulodesis dorsal en los resultados postoperatorios. Pacientes y métodos Se evaluaron dos grupos con ocho pacientes cada uno: el grupo A, de resección artroscópica simple (RAS), y el grupo B, de resección artroscópica combinada con capsulodesis dorsal (RACD). Resultados La edad media del grupo A fue de 36,10 ± 7,96 (rango: 28–53) años, y la del grupo B fue de 34,17 ± 29,60 (rango: 18–44) años. El período de seguimiento fue de 30,67 ± 13,90 (rango: 13,45–53,55) meses y 29,60 ± 16,80 (rango: 12,68–62,13) meses, respectivamente. Para ambos grupos, se logró una disminución significativa en la escala visual analógica (EVA) posoperatoria (alrededor de 2/10), y los valores del cuestionario de Discapacidades del Brazo, Hombro y Mano ( Disabilities of the Arm, Shoulder and Hand , DASH, en inglés) estuvieron por debajo de 5/100. Todos los parámetros funcionales (rango de movimiento y fuerza) estuvieron por encima del 80% del lado contralateral, sin diferencias entre grupos. Más del 75% de los pacientes quedaron completamente satisfechos. Hubo una diferencia estadísticamente significativa para la tasa de recurrencia entre","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e34 - e42"},"PeriodicalIF":0.0,"publicationDate":"2022-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48464664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Vilardo Cerqueira Guedes, D. Jácome, G. F. Alves, Anderson Vieira Monteiro
Abstract Introduction Glomus tumors are benign, characterized by microvascular alteration, and mostly found in the subungual region of the hand. They are rare and associated with paroxysmal pain, tenderness on palpation, and thermal sensitivity. The aim of the present research was to analyze the epidemiology of glomus tumors and relate each of the variables with cases of recurrence. Materials and Methods A retrospective review of medical records was undertaken in our hospital to collect epidemiological numerical variables (time between the onset of symptoms and diagnosis and surgery, age, size of the tumor on magnetic resonance imaging and the histopathological examination, time until recurrence and reoperation after surgery, duration of the follow-up) and categorical variables (gender, ethnicity, laterality, affected finger, location in the hand, surgical technique, smoking, preoperative symptoms, recurrence, and comorbidities). Then, we performed a statistical analysis to identify possible associations of the hand tumors with recurrences. Results The review identified 66 patients with glomus tumors 52 of which were located in the hand. The mean age of the sample was 49 years, and it was mostly composed of white female patients. Pain was the main related symptom, and most tumors presented sizes between 5 mm and 1 cm. Among the 52 patients, 11 cases presented recurrences, with a mean time until onset of 39.4 months, but 3 of them were initially operated on at other hospitals. None of the variables was shown to be a predictor of recurrence, although we saw that bone involvement on radiographs was only present in certain cases of recurrence. Conclusion The sample studied was large for this rare disease, and reinforced previous results regarding its epidemiology. As 54% of the cases of recurrence occurred at least twice, we think that genetic, histological and immunohistochemical analyses should be the focus of futures studies, as well as a search for bone and tendon involvement. Resumen Introducción Los tumores glómicos son benignos, caracterizados por una alteración microvascular, y se encuentran con más frecuencia en la región subungueal de la mano. Son raros, y están asociados con dolor paroxístico, y sensibilidad al tacto y térmica. El objetivo de esta investigación fue analizar la epidemiología de los tumores glómicos y relacionar cada una de las variables con casos de recurrencia. Materiales y métodos Se realizó una revisión retrospectiva de los historiales en nuestro hospital para recoger variables epidemiológicas numéricas (tiempo entre el inicio de los síntomas y el diagnóstico y la cirugía, edad, tamaño del tumor en resonancia magnética y en el examen histopatológico, tiempo hasta la recurrencia y la reintervención después de la cirugía, y tiempo de seguimiento) y categóricas (género, etnia, lateralidad, dedo afectado, localización en la mano, técnica quirúrgica, tabaquismo, síntomas preoperatorios, recurrencia, y comorbilidades). L
{"title":"Epidemiological Analysis of Glomus Tumors of the Hand and Association with Recurrence Rate","authors":"Giovanni Vilardo Cerqueira Guedes, D. Jácome, G. F. Alves, Anderson Vieira Monteiro","doi":"10.1055/s-0042-1744466","DOIUrl":"https://doi.org/10.1055/s-0042-1744466","url":null,"abstract":"Abstract Introduction Glomus tumors are benign, characterized by microvascular alteration, and mostly found in the subungual region of the hand. They are rare and associated with paroxysmal pain, tenderness on palpation, and thermal sensitivity. The aim of the present research was to analyze the epidemiology of glomus tumors and relate each of the variables with cases of recurrence. Materials and Methods A retrospective review of medical records was undertaken in our hospital to collect epidemiological numerical variables (time between the onset of symptoms and diagnosis and surgery, age, size of the tumor on magnetic resonance imaging and the histopathological examination, time until recurrence and reoperation after surgery, duration of the follow-up) and categorical variables (gender, ethnicity, laterality, affected finger, location in the hand, surgical technique, smoking, preoperative symptoms, recurrence, and comorbidities). Then, we performed a statistical analysis to identify possible associations of the hand tumors with recurrences. Results The review identified 66 patients with glomus tumors 52 of which were located in the hand. The mean age of the sample was 49 years, and it was mostly composed of white female patients. Pain was the main related symptom, and most tumors presented sizes between 5 mm and 1 cm. Among the 52 patients, 11 cases presented recurrences, with a mean time until onset of 39.4 months, but 3 of them were initially operated on at other hospitals. None of the variables was shown to be a predictor of recurrence, although we saw that bone involvement on radiographs was only present in certain cases of recurrence. Conclusion The sample studied was large for this rare disease, and reinforced previous results regarding its epidemiology. As 54% of the cases of recurrence occurred at least twice, we think that genetic, histological and immunohistochemical analyses should be the focus of futures studies, as well as a search for bone and tendon involvement. Resumen Introducción Los tumores glómicos son benignos, caracterizados por una alteración microvascular, y se encuentran con más frecuencia en la región subungueal de la mano. Son raros, y están asociados con dolor paroxístico, y sensibilidad al tacto y térmica. El objetivo de esta investigación fue analizar la epidemiología de los tumores glómicos y relacionar cada una de las variables con casos de recurrencia. Materiales y métodos Se realizó una revisión retrospectiva de los historiales en nuestro hospital para recoger variables epidemiológicas numéricas (tiempo entre el inicio de los síntomas y el diagnóstico y la cirugía, edad, tamaño del tumor en resonancia magnética y en el examen histopatológico, tiempo hasta la recurrencia y la reintervención después de la cirugía, y tiempo de seguimiento) y categóricas (género, etnia, lateralidad, dedo afectado, localización en la mano, técnica quirúrgica, tabaquismo, síntomas preoperatorios, recurrencia, y comorbilidades). L","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e27 - e33"},"PeriodicalIF":0.0,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49306216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Blanco, P. G. Barbero, M. Aparicio, J. P. Correa
Abstract Irreducible dislocation of the radial head is an extremely rare lesion, especially in an adult patient. We present a case of diaphyseal radius fracture associated with a posterior elbow dislocation and an irreducible radial head dislocation. After closed reduction of the elbow, we performed open reduction and ostheosynthesis of the radius, and the radial head remained irreducible. We finally found, surrounding the radius, the interposition of the insertion of the biceps, and, after extracting it, we performed the correct reduction of the radial head. Six months after the surgery, the patient presented a full articular balance, with no pain. We have not found any similar case in the literature. Resumen La luxación no reductible de cabeza radial es una lesión extremadamente infrecuente, especialmente en el paciente adulto. Presentamos el caso de una fractura diafisaria de radio asociada a una luxación posterior de codo y a una luxación irreductible de la cabeza radial. Tras una reducción cerrada de codo, se realizó la reducción abierta y osteosíntesis de radio, permaneciendo irreductible la cabeza radial. Finalmente hallamos circundando al radio la interposición de la inserción del bíceps, y, tras la retirada de la misma, realizamos la correcta reducción de la cabeza radial. Seis meses tras la cirugía, el paciente presentaba un balance articular completo sin dolor. No hemos hallado en la literatura ningún caso similar.
摘要桡骨头不可复位脱位是一种极其罕见的病变，尤其是在成人患者中。我们报告一例桡骨骨干骨折合并后侧肘关节脱位和无法复位的桡骨头脱位。在肘关节闭合复位后，我们进行了桡骨切开复位和骨融合，桡骨头仍然无法复位。我们最终在桡骨周围找到了二头肌的插入点，在取出它之后，我们进行了正确的桡骨头复位。术后6个月，患者关节完全平衡，无疼痛。我们在文献中没有发现类似的案例。Resumen La luxación no reductible de cabeza radial es una lesión极端不常见，尤其是在成人中。现报道一例桡骨骨折合并luxación后侧骨折合并luxación桡骨不复位骨折。Tras una reducción cerrada de codo, se realizó la reducción abierta y osteosíntesis de radio, permaneciendo irreductible la cabeza radial。最后，hallamos cirundando al radio la interposición de la inserción del bíceps, y, tras la retirada de la misma, realizamos la correcta reducción de la cabeza radial。Seis meses tras la cirugía, el pacente呈现一个不平衡的特别完整的美元。No hemos hallado en la literaturningún caso similar。
{"title":"Diaphyseal Radius Fracture Associated with Irreducible Head Dislocation. Case Report Fractura diafisaria de radio asociada a luxación irreductible de la cabeza. Relato de caso","authors":"A. Blanco, P. G. Barbero, M. Aparicio, J. P. Correa","doi":"10.1055/s-0041-1731768","DOIUrl":"https://doi.org/10.1055/s-0041-1731768","url":null,"abstract":"Abstract Irreducible dislocation of the radial head is an extremely rare lesion, especially in an adult patient. We present a case of diaphyseal radius fracture associated with a posterior elbow dislocation and an irreducible radial head dislocation. After closed reduction of the elbow, we performed open reduction and ostheosynthesis of the radius, and the radial head remained irreducible. We finally found, surrounding the radius, the interposition of the insertion of the biceps, and, after extracting it, we performed the correct reduction of the radial head. Six months after the surgery, the patient presented a full articular balance, with no pain. We have not found any similar case in the literature. Resumen La luxación no reductible de cabeza radial es una lesión extremadamente infrecuente, especialmente en el paciente adulto. Presentamos el caso de una fractura diafisaria de radio asociada a una luxación posterior de codo y a una luxación irreductible de la cabeza radial. Tras una reducción cerrada de codo, se realizó la reducción abierta y osteosíntesis de radio, permaneciendo irreductible la cabeza radial. Finalmente hallamos circundando al radio la interposición de la inserción del bíceps, y, tras la retirada de la misma, realizamos la correcta reducción de la cabeza radial. Seis meses tras la cirugía, el paciente presentaba un balance articular completo sin dolor. No hemos hallado en la literatura ningún caso similar.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e155 - e159"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47586271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pau López-Osornio de Vega, Vicente Carratalà Bauxauli, F. Corella, C. Andrade
Abstract Scaffolds, either alone or combined with cultured chondrocyte cells, are an effective treatment for chondral or osteochondral defects of the knee and ankle joints. Scaffolds are a more sophisticated solution and have some advantages compared with the isolated use of the more traditional treatments of microfractures or nanofractures. In addition, scaffolds represent a less complicated technique and a less expensive treatment compared with chondrocyte culture treatments, which are accessible by very few patients. In the present article, we detail the surgical technique and provide advices and tips for the treatment of ostecochondral hand and wrist lesions using the Chondro-Gide (Geistlich Pharma AG, Wolhausen, Switzerland) scaffold and its patented autologous matrix-induced chondrogenesis (AMIC, Geistlich Pharma AG) technique. Resumen Las matrices, ya sea utilizadas de forma aislada o asociadas al cultivo de condrocitos, se han demostrado una técnica quirúrgica eficaz para el tratamiento de las lesiones condrales u osteocondrales en rodilla, tobillo y cadera. Son una alternativa más sofisticada, y aportan algunas ventajas respecto a las más tradicionales técnicas de microfracturas o nanofracturas, usadas éstas de forma aislada. Asimismo, representan una técnica menos complicada logísticamente y mucho menos cara que las tradicionales del cultivo de condrocitos, al alcance de muy pocos pacientes. En este artículo, detallamos la técnica a emplear, así como algunas recomendaciones, para el tratamiento de dichas lesiones, en mano y muñeca, mediante la utilización de la matriz de colágeno de origen porcino denominada Chondro-Gide (Geistlich Pharma AG, Wolhausen, Suiza) y su técnica registrada de condrogénesis autóloga inducida por matriz (autologous matrix-induced chondrogenesis, AMIC, en inglés; Geistlich Pharma AG).
支架无论是单独使用还是与培养的软骨细胞联合使用，都是治疗膝关节和踝关节软骨或骨软骨缺损的有效方法。支架是一种更复杂的解决方案，与孤立使用更传统的微骨折或纳米骨折治疗方法相比，支架具有一些优势。此外，与软骨细胞培养治疗相比，支架代表了一种更简单的技术和更便宜的治疗方法，很少有患者可以使用软骨细胞培养治疗。在本文中，我们详细介绍了手术技术，并提供了使用chondroo - gide (Geistlich Pharma AG, Wolhausen, Switzerland)支架及其专利的自体基质诱导软骨形成(AMIC, Geistlich Pharma AG)技术治疗手和手腕骨软骨病变的建议和提示。资料来源:资料来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:文献来源:另一种替代方法是más复杂结构，即与más传统的微断裂和纳米结构相比， δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ δ。Asimismo，代表了一种复杂的化学物质logísticamente，许多化学物质都是由传统的化学物质和复杂的化学物质组成的，许多化学物质都是由复杂的化学物质组成的。En este artículo, detallamos la tsamicnica a emar, así como algunas建议，para el tramiento de dichalesones, En mano y muñeca, mediante la utilización de la matriz de colágeno de origen porcino denominada chondrogide(瑞士Geistlich制药公司，Wolhausen，瑞士)y su csamicnica registrada de condrogsamess autóloga inducida pmatriz(自体基质诱导的软骨形成，AMIC, En ingimacomm;Geistlich Pharma AG)。
{"title":"AMIC Technique for the Treatment of Chondral Injuries of the Hand and Wrist Técnica AMIC para el tratamiento de las lesiones condrales de mano y muñeca","authors":"Pau López-Osornio de Vega, Vicente Carratalà Bauxauli, F. Corella, C. Andrade","doi":"10.1055/s-0041-1739163","DOIUrl":"https://doi.org/10.1055/s-0041-1739163","url":null,"abstract":"Abstract Scaffolds, either alone or combined with cultured chondrocyte cells, are an effective treatment for chondral or osteochondral defects of the knee and ankle joints. Scaffolds are a more sophisticated solution and have some advantages compared with the isolated use of the more traditional treatments of microfractures or nanofractures. In addition, scaffolds represent a less complicated technique and a less expensive treatment compared with chondrocyte culture treatments, which are accessible by very few patients. In the present article, we detail the surgical technique and provide advices and tips for the treatment of ostecochondral hand and wrist lesions using the Chondro-Gide (Geistlich Pharma AG, Wolhausen, Switzerland) scaffold and its patented autologous matrix-induced chondrogenesis (AMIC, Geistlich Pharma AG) technique. Resumen Las matrices, ya sea utilizadas de forma aislada o asociadas al cultivo de condrocitos, se han demostrado una técnica quirúrgica eficaz para el tratamiento de las lesiones condrales u osteocondrales en rodilla, tobillo y cadera. Son una alternativa más sofisticada, y aportan algunas ventajas respecto a las más tradicionales técnicas de microfracturas o nanofracturas, usadas éstas de forma aislada. Asimismo, representan una técnica menos complicada logísticamente y mucho menos cara que las tradicionales del cultivo de condrocitos, al alcance de muy pocos pacientes. En este artículo, detallamos la técnica a emplear, así como algunas recomendaciones, para el tratamiento de dichas lesiones, en mano y muñeca, mediante la utilización de la matriz de colágeno de origen porcino denominada Chondro-Gide (Geistlich Pharma AG, Wolhausen, Suiza) y su técnica registrada de condrogénesis autóloga inducida por matriz (autologous matrix-induced chondrogenesis, AMIC, en inglés; Geistlich Pharma AG).","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e165 - e175"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46023367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iker Miguel Escuredo, Guillermo Ibarrondo Arzua, Juan José García Gutiérrez
Abstract Metacarpal hand is one of the most devastating upper-extremity lesions. We report a case of a multidigit amputation corresponding to a Wei et al.5 IA metacarpal hand in a 56 year-old-male. He underwent a sequential toe-to-hand transfer to the third and fourth radii. Reconstruction of the metacarpal hand, either in an acute or deferred presentation, must consider some reconstructive principles, including the identification of the structures to be spared and the coverage strategies for the acute stage. Toe-to-hand transfer is the preferred technique when replantation is not an option. It is critical to know which structures should be transferred to which positions, as well as to adapt the reconstructive plan to the characteristics from each patient. Resumen La mano metacarpiana es una de las lesiones más devastadoras de la extremidad superior. Nuestro caso clínico corresponde a un varón de 56 años con una amputación multidigital de la cual resultó una mano metacarpiana tipo IA de Wei. Se planteó la reconstrucción con la transferencia secuencial de dos dedos de pie a la mano en los radios tercero y cuarto. A la hora de plantearnos la reconstrucción de una mano metacarpiana, tanto de forma aguda como diferida, es necesario tener en cuenta ciertos principios reconstructivos. En primer lugar, las estructuras vitales a conservar y los métodos de cobertura en el proceso agudo. Cuando el reimplante no es posible, la transferencia de dedos del pie a la mano es la técnica de elección. Es necesario conocer qué estructuras y a qué posiciones se debe realizar la transferencia, así como adecuar las opciones a las características de cada paciente.
掌骨手是上肢最具破坏性的病变之一。我们报告一例56岁男性的多指截肢，对应于Wei等人5 IA掌骨手。他接受了连续的第三和第四桡骨骨转移手术。掌骨手的重建，无论是急性期还是延迟期，都必须考虑一些重建原则，包括确定要保留的结构和急性期的覆盖策略。当不能进行再植时，脚趾到手移植是首选的技术。了解哪些结构应该转移到哪个位置，以及根据每个患者的特点调整重建计划是至关重要的。resume . resume . resume . resume . resume . resume . resume .续写。Nuestro caso clínico对应一个un varón de 56 años con una amputación multidigital de la cual resultó una mano metacpiana tipo IA de Wei。请参见planteó la reconstrucción con la transferencia secuencial dedos dedos de pie a la mano en los radio tercero by cuarto。从植物的角度看，植物与植物之间的关系，即生物多样性的关系，是现代人类重建原则的必要条件。在初级蔗糖中，纤维素的结构是一种保守的蛋白质，它可以在蛋白质的合成过程中起到一定的作用。再重新种植没有任何可能的方法，可以将这些方法转移到其他方法上，也可以将这些方法转移到elección上。需要关注的是，通过一个ququest posiciones的结构，可以实现转移，así como adquar opciones和características de cada paciente。
{"title":"Reconstructive Principles for the Metacarpal Hand: Case Report Principios reconstructivos en la mano metacarpiana: relato de caso","authors":"Iker Miguel Escuredo, Guillermo Ibarrondo Arzua, Juan José García Gutiérrez","doi":"10.1055/s-0041-1731769","DOIUrl":"https://doi.org/10.1055/s-0041-1731769","url":null,"abstract":"Abstract Metacarpal hand is one of the most devastating upper-extremity lesions. We report a case of a multidigit amputation corresponding to a Wei et al.5 IA metacarpal hand in a 56 year-old-male. He underwent a sequential toe-to-hand transfer to the third and fourth radii. Reconstruction of the metacarpal hand, either in an acute or deferred presentation, must consider some reconstructive principles, including the identification of the structures to be spared and the coverage strategies for the acute stage. Toe-to-hand transfer is the preferred technique when replantation is not an option. It is critical to know which structures should be transferred to which positions, as well as to adapt the reconstructive plan to the characteristics from each patient. Resumen La mano metacarpiana es una de las lesiones más devastadoras de la extremidad superior. Nuestro caso clínico corresponde a un varón de 56 años con una amputación multidigital de la cual resultó una mano metacarpiana tipo IA de Wei. Se planteó la reconstrucción con la transferencia secuencial de dos dedos de pie a la mano en los radios tercero y cuarto. A la hora de plantearnos la reconstrucción de una mano metacarpiana, tanto de forma aguda como diferida, es necesario tener en cuenta ciertos principios reconstructivos. En primer lugar, las estructuras vitales a conservar y los métodos de cobertura en el proceso agudo. Cuando el reimplante no es posible, la transferencia de dedos del pie a la mano es la técnica de elección. Es necesario conocer qué estructuras y a qué posiciones se debe realizar la transferencia, así como adecuar las opciones a las características de cada paciente.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e160 - e164"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46998759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Pereira, A. Ribau, T. Barbosa, F. Rodrigues, Diogo Catelas, P. Neves
Abstract Introduction Fifth metacarpal neck fractures are extremely common, but there is still no consensus regarding the ideal course of treatment. Volar angulation and shortening are decisive factors; however, there is still controversy about the cut-off values that translate into worse clinical results. The present study aims to answer these questions in order to provide additional data to aid in the clinical practice and decision making. Materials and Methods A retrospective study evaluated patients with fifth metacarpal fractures treated between 2013 and 2018. A total of 133 patients were included, with an average follow-up of 2 months. Surgery was performed in 21 patients, and 112 were treated conservatively. The radiological assessment of volar anguation and shortening was based in the first and last radiographs of the follow-up. The patients were contacted and submited to a questionnaire that included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and subjective evaluations of pain (Visual Analogue Scale, VAS), hand strength, stiffness and finger mobility, and cosmetic result. Results Surgery was more successful in reducing angulation than the conservative treatment, achieving more anatomic final values for angulation and shortening (p < 0.05). On the other hand, surgery seems to be associated with a higher notion of limited finger mobility (p = 0.02). Among patients treated conservatively, inicial angulations > 60° and final angulations > 50° were associated with worse cosmetic results (p = 0,039). Final shortening > 4 mm translated into a higher notion of stiffness and limited finger mobility (p = 0.034). More advanced age showed a correlation with higher scores on the VAS (p = 0.023) and QuickDASH (p < 0,001). Female patients (p = 0.02) were also associated with higher VAS scores. The overall satisfaction rate was of 97%. Conclusion Although globally the functional outcome of these fractures is very good, the present study reports several factors that should be considered when treating fifth metacarpal neck fractures. Resumen Introducción Las fracturas del cuello del quinto metacarpiano son muy comunes, pero no hay consenso sobre el tratamiento de elección. Angulación y reducción son factores decisivos en la elección del tratamiento; sin embargo, hay alguna controversia sobre los valores a partir de los cuales se da un peor resultado clínico. Este estudio busca responder a estas cuestiones a fin de proporcionar una evidencia más para auxiliar en la decisión terapéutica. Materiales y Métodos Este estudio retrospectivo evaluó a enfermos con fractura del quinto metacarpiano tratados entre 2013 y 2018. Se incluyó en el estudio a 133 enfermos, con 2 meses de seguimiento medio. Se trató quirúrgicamente a 21 enfermos, y a 112 se aplicó el tratamiento conservador. La evaluación radiográfica de la angulación volar y acortamiento se basó en las imágenes al inicio y al final del seguimiento médico. Se contactó a los enferm
摘要简介 第五掌骨颈骨折非常常见，但对于理想的治疗方案仍没有达成共识。Volar成角和缩短是决定性因素；然而，对于转化为更差临床结果的临界值仍然存在争议。本研究旨在回答这些问题，以便为临床实践和决策提供额外的数据。材料和方法 一项回顾性研究评估了2013年至2018年间接受治疗的第五掌骨骨折患者。共纳入133名患者，平均随访2个月。21名患者接受了手术治疗，112名患者接受保守治疗。根据随访的第一张和最后一张x线片对掌侧疼痛和缩短进行放射学评估。患者被联系并提交了一份问卷，其中包括手臂、肩膀和手部快速残疾（QuickDASH）评分和疼痛的主观评估（视觉模拟量表，VAS）、手部力量、僵硬和手指活动性，以及美容结果。后果 手术在减少成角方面比保守治疗更成功，在成角和缩短方面获得了更多的解剖学最终值（p 60°和最终角度 > 50°与较差的美容效果相关（p = 0039）。最终缩短 > 4. mm转化为更高的硬度和有限的手指活动性的概念（p = 0.034）。年龄越大，VAS评分越高（p = 0.023）和QuickDASH（p 60°y决赛 > 50°se asocian a un peor resultado estético（p = 0039）。Valores de acortamiento最终优势a 4 这是一个移动市长的限制（p = 0034）。在EVA中，市场份额与市场份额的相关性（p = 0023）y en el QuickDASH（p < 0001）。Las mujeres（p = 0,02）在EVA中，这是一个很好的例子。儿童对教育的满意度为97%。结论 作为一个结果，儿童的功能是一个重要的因素，它决定了五掌骨骨折的治疗时间。
{"title":"Fifth Metacarpal Neck Fractures: Outcome-influencing Factors Fracturas del cuello del quinto metacarpiano: factores que influyen en el resultado","authors":"C. Pereira, A. Ribau, T. Barbosa, F. Rodrigues, Diogo Catelas, P. Neves","doi":"10.1055/s-0041-1739170","DOIUrl":"https://doi.org/10.1055/s-0041-1739170","url":null,"abstract":"Abstract Introduction Fifth metacarpal neck fractures are extremely common, but there is still no consensus regarding the ideal course of treatment. Volar angulation and shortening are decisive factors; however, there is still controversy about the cut-off values that translate into worse clinical results. The present study aims to answer these questions in order to provide additional data to aid in the clinical practice and decision making. Materials and Methods A retrospective study evaluated patients with fifth metacarpal fractures treated between 2013 and 2018. A total of 133 patients were included, with an average follow-up of 2 months. Surgery was performed in 21 patients, and 112 were treated conservatively. The radiological assessment of volar anguation and shortening was based in the first and last radiographs of the follow-up. The patients were contacted and submited to a questionnaire that included the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score and subjective evaluations of pain (Visual Analogue Scale, VAS), hand strength, stiffness and finger mobility, and cosmetic result. Results Surgery was more successful in reducing angulation than the conservative treatment, achieving more anatomic final values for angulation and shortening (p < 0.05). On the other hand, surgery seems to be associated with a higher notion of limited finger mobility (p = 0.02). Among patients treated conservatively, inicial angulations > 60° and final angulations > 50° were associated with worse cosmetic results (p = 0,039). Final shortening > 4 mm translated into a higher notion of stiffness and limited finger mobility (p = 0.034). More advanced age showed a correlation with higher scores on the VAS (p = 0.023) and QuickDASH (p < 0,001). Female patients (p = 0.02) were also associated with higher VAS scores. The overall satisfaction rate was of 97%. Conclusion Although globally the functional outcome of these fractures is very good, the present study reports several factors that should be considered when treating fifth metacarpal neck fractures. Resumen Introducción Las fracturas del cuello del quinto metacarpiano son muy comunes, pero no hay consenso sobre el tratamiento de elección. Angulación y reducción son factores decisivos en la elección del tratamiento; sin embargo, hay alguna controversia sobre los valores a partir de los cuales se da un peor resultado clínico. Este estudio busca responder a estas cuestiones a fin de proporcionar una evidencia más para auxiliar en la decisión terapéutica. Materiales y Métodos Este estudio retrospectivo evaluó a enfermos con fractura del quinto metacarpiano tratados entre 2013 y 2018. Se incluyó en el estudio a 133 enfermos, con 2 meses de seguimiento medio. Se trató quirúrgicamente a 21 enfermos, y a 112 se aplicó el tratamiento conservador. La evaluación radiográfica de la angulación volar y acortamiento se basó en las imágenes al inicio y al final del seguimiento médico. Se contactó a los enferm","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e115 - e120"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46427175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Hook of hamate fractures are rare. The best treatment option is a source of debate; it ranges from conservative to surgical techniques, including resection of the hook or a volar approach followed by internal fixation. These techniques are not exempt from risk. Minimal invasive fixation using a dorsal percutaneous approach and a headless, cannulated mini screw is another option, although not commonly considered. We present a case series of patients who underwent this surgical technique. Methods This is a retrospective review of four patients with nondisplaced hook of hamate fractures treated with dorsal percutaneous fixation. The evaluation included symptoms, physical examination, and radiological (radiographs, magnetic resonance imaging [MRI], and computed tomography [CT]) findings, as well as pre and postoperative strength (determined with a Jamar (JLW Instruments, Chicago, USA) hydraulic dynamometer) and quick disabilities of the arm, shoulder and hand (QuickDASH) scores. Results The union rate was 100% with no associated complications. All patients resumed their preinjury activities 3 months after the surgery and reported they would undergo surgery again if needed. Conclusion This retrospective study shows that safe treatment of nondisplaced hook of hamate fractures with percutaneous dorsal fixation is feasible, with excellent clinical outcomes. In any case, our sample is limited, and further studies are required. Resumen Introducción Las fracturas del gancho del ganchoso son infrecuentes. Se debate el tratamiento óptimo, desde el conservador hasta técnicas quirúrgicas, que incluyen la resección del gancho o un abordaje volar y fijación interna. Estas técnicas no están exentas de riesgo. Una alternativa reciente y segura es la fijación interna mediante un abordaje dorsal percutáneo. Presentamos una serie de casos de pacientes a los que se aplicó esta técnica en fracturas agudas o con retrasos de unión. Métodos En este estudio, se han revisado 4 pacientes con fracturas del gancho del ganchoso no desplazadas, de hasta 9 meses de evolución, intervenidos mediante una fijación percutánea dorsal. Se revisó la sintomatología, la exploración física, y la radiología (radiografías, resonancia magnética [RM] y tomografía computarizada [TC]). Se evaluó la fuerza de presión mediante el dinamómetro de Jamar (JLW Instruments, Chicago, IL, USA) y el puntaje en la versión corta del cuestionario de Discapacidades del Brazo, Hombro y Mano (Quick Disabilities of the Arm, Shoulder and Hand, Quick DASH, en inglés) pre y postoperatorios. Resultados En el 100% de los casos, se consiguió la unión de la fractura, sin complicaciones asociadas. En tres de los cuatro casos, la fractura ocurrió en la mano no dominante. Todos los pacientes volvieron a su actividad habitual tres meses después, y declararon que volverían a operarse con esta técnica si fuera necesario. Conclusión Este estudio retrospectivo muestra que las fracturas no desplazadas del gan
钩骨骨折是一种罕见的骨折。最佳治疗方案是一个争论的来源;治疗范围从保守到手术技术，包括切除钩骨或掌侧入路后内固定。这些技术并非没有风险。采用背侧经皮入路和无头空心微型螺钉进行微创固定是另一种选择，尽管不常被考虑。我们提出一个病例系列的病人谁接受这种手术技术。方法回顾性分析4例非移位钩骨骨折经背侧经皮固定治疗的病例。评估包括症状、体格检查、放射学(x线片、磁共振成像[MRI]和计算机断层扫描[CT])结果，以及术前和术后力量(用Jamar (JLW Instruments, Chicago, USA)水力测力仪测定)和手臂、肩部和手部的快速残疾(QuickDASH)评分。结果愈合率100%，无并发症发生。所有患者术后3个月均恢复损伤前活动，并报告如有需要将再次接受手术。结论本回顾性研究表明经皮背侧固定治疗钩骨非移位骨折是可行的，临床效果良好。无论如何，我们的样本是有限的，需要进一步的研究。简历Introducción Las fracturas del ganchoo del ganchoso son infrecentes。我们讨论了过渡过渡组织óptimo，我们讨论了过渡过渡组织quirúrgicas，包括过渡过渡组织quirúrgicas和过渡过渡组织fijación。Estas tsamicnicas no están exentas de riesgo。Una alternativa reciente segura y es洛杉矶成为interna mediante联合国abordaje背percutaneo。目前，有一系列的病例表明，患者的病情可能会发生变化，例如aplicó，患者的病情可能会发生变化，例如:unión。3 .在研究中，研究人员对4例骨折患者进行了修正，发现了9例骨折患者evolución，中间干预者fijación percutánea背部。Se revisó la sintomatología, la exploración física, y la radiología (radiografías, resonancia magniztica [RM] y tomografía computarizada [TC])。见evaluó la fuerza de presión mediante el dinamómetro de Jamar (JLW Instruments, Chicago, IL, USA)和el puntaje en la versión corta del Discapacidades del Brazo, Hombro y Mano(手臂、肩膀和手的快速残疾，Quick DASH, en inglsamos)手术前和术后。结果患者骨折发生率为100%，骨折发生率为consiguió la unión，并发症发生率为0。三层楼高，一层楼高ocurrió一层楼高，一层楼高。Todos丧失了患者的心理健康，并习惯性地将其视为一种累赘，通过宣布其行为方式volverían和公开地将其视为一种必要的累赘。Conclusión骨裂后骨折的回顾性研究中心fijación percutánea背侧，骨裂后形成，合并结果clínico优。因此，新大学是有限的，通过实现más工作室。
{"title":"Percutaneous Dorsal Approach for Fractures of the Hook of the Hamate: A Less Common but Effective Option Abordaje dorsal percutáneo para las fracturas del gancho del ganchoso: una alternativa menos común pero eficaz","authors":"Borja Gómez, Á. Olea, Virginia Sierra","doi":"10.1055/s-0041-1741322","DOIUrl":"https://doi.org/10.1055/s-0041-1741322","url":null,"abstract":"Abstract Introduction Hook of hamate fractures are rare. The best treatment option is a source of debate; it ranges from conservative to surgical techniques, including resection of the hook or a volar approach followed by internal fixation. These techniques are not exempt from risk. Minimal invasive fixation using a dorsal percutaneous approach and a headless, cannulated mini screw is another option, although not commonly considered. We present a case series of patients who underwent this surgical technique. Methods This is a retrospective review of four patients with nondisplaced hook of hamate fractures treated with dorsal percutaneous fixation. The evaluation included symptoms, physical examination, and radiological (radiographs, magnetic resonance imaging [MRI], and computed tomography [CT]) findings, as well as pre and postoperative strength (determined with a Jamar (JLW Instruments, Chicago, USA) hydraulic dynamometer) and quick disabilities of the arm, shoulder and hand (QuickDASH) scores. Results The union rate was 100% with no associated complications. All patients resumed their preinjury activities 3 months after the surgery and reported they would undergo surgery again if needed. Conclusion This retrospective study shows that safe treatment of nondisplaced hook of hamate fractures with percutaneous dorsal fixation is feasible, with excellent clinical outcomes. In any case, our sample is limited, and further studies are required. Resumen Introducción Las fracturas del gancho del ganchoso son infrecuentes. Se debate el tratamiento óptimo, desde el conservador hasta técnicas quirúrgicas, que incluyen la resección del gancho o un abordaje volar y fijación interna. Estas técnicas no están exentas de riesgo. Una alternativa reciente y segura es la fijación interna mediante un abordaje dorsal percutáneo. Presentamos una serie de casos de pacientes a los que se aplicó esta técnica en fracturas agudas o con retrasos de unión. Métodos En este estudio, se han revisado 4 pacientes con fracturas del gancho del ganchoso no desplazadas, de hasta 9 meses de evolución, intervenidos mediante una fijación percutánea dorsal. Se revisó la sintomatología, la exploración física, y la radiología (radiografías, resonancia magnética [RM] y tomografía computarizada [TC]). Se evaluó la fuerza de presión mediante el dinamómetro de Jamar (JLW Instruments, Chicago, IL, USA) y el puntaje en la versión corta del cuestionario de Discapacidades del Brazo, Hombro y Mano (Quick Disabilities of the Arm, Shoulder and Hand, Quick DASH, en inglés) pre y postoperatorios. Resultados En el 100% de los casos, se consiguió la unión de la fractura, sin complicaciones asociadas. En tres de los cuatro casos, la fractura ocurrió en la mano no dominante. Todos los pacientes volvieron a su actividad habitual tres meses después, y declararon que volverían a operarse con esta técnica si fuera necesario. Conclusión Este estudio retrospectivo muestra que las fracturas no desplazadas del gan","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e90 - e96"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43115876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes. Resumen Introducción El diagnóstico
{"title":"Arthroscopic Lunotriquetral Ligamentoplasty, from the Cadaver Lab to the Clinical Practice Ligamentoplastia lunotriquetral artroscópica, de la sala de disección a la práctica clínica","authors":"M. Cruz-Sánchez, Cristóbal Martínez-Andrade","doi":"10.1055/s-0041-1740093","DOIUrl":"https://doi.org/10.1055/s-0041-1740093","url":null,"abstract":"Abstract Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes. Resumen Introducción El diagnóstico ","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e121 - e127"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45242321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Homid Fahandezh-Saddi Díaz, F. Fernández, Á. Horcajadas, Manuel Villanueva Martínez, María Elena Cantero Yubero
Abstract In the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office. The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit. Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome. The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients. Resumen En los últimos años, la ecografía de muñeca y mano ha aumentado en popularidad. Los avances técnicos nos llevaron a mejorar la calidad de la imagen y a tener la capacidad de ver estructuras superficiales de tejidos blandos con alta resolución con el paciente en nuestro consultorio. Las ventajas de la ecografía son el hecho de que es no invasiva, su falta de radiación ionizante, el bajo costo y la portabilidad. La evaluación dinámica y en tiempo real en el consultorio es un beneficio adicional. El ultrasonido puede ser utilizado en la cirugía de la mano con fines diagnósticos y terapéuticos. Podemos utilizar la ecografía para inyecciones con guía de aguja, para la evaluación de masas de tejidos blandos, cuerpos extraños, lesiones de tendones, neuropatías compresivas, y enfermedad articular reumatológica. También nos ayuda a realizar procedimientos guiados por ecografía: síndrome del túnel carpiano, dedo en gatillo, síndrome de intersección, o síndrome compartimental. El objetivo de la presente revisión es describir diferentes utilidades de la ecografía en cirugía de mano que muestran el importante papel de la ecografía en ayudar al cirujano a tener más información de la enfermedad del paciente.
{"title":"Usefulness of the Ultrasound in Hand Surgery: Part I Utilidad de la ecografía en la cirugía de la mano: parte I","authors":"Homid Fahandezh-Saddi Díaz, F. Fernández, Á. Horcajadas, Manuel Villanueva Martínez, María Elena Cantero Yubero","doi":"10.1055/s-0041-1739295","DOIUrl":"https://doi.org/10.1055/s-0041-1739295","url":null,"abstract":"Abstract In the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office. The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit. Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome. The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients. Resumen En los últimos años, la ecografía de muñeca y mano ha aumentado en popularidad. Los avances técnicos nos llevaron a mejorar la calidad de la imagen y a tener la capacidad de ver estructuras superficiales de tejidos blandos con alta resolución con el paciente en nuestro consultorio. Las ventajas de la ecografía son el hecho de que es no invasiva, su falta de radiación ionizante, el bajo costo y la portabilidad. La evaluación dinámica y en tiempo real en el consultorio es un beneficio adicional. El ultrasonido puede ser utilizado en la cirugía de la mano con fines diagnósticos y terapéuticos. Podemos utilizar la ecografía para inyecciones con guía de aguja, para la evaluación de masas de tejidos blandos, cuerpos extraños, lesiones de tendones, neuropatías compresivas, y enfermedad articular reumatológica. También nos ayuda a realizar procedimientos guiados por ecografía: síndrome del túnel carpiano, dedo en gatillo, síndrome de intersección, o síndrome compartimental. El objetivo de la presente revisión es describir diferentes utilidades de la ecografía en cirugía de mano que muestran el importante papel de la ecografía en ayudar al cirujano a tener más información de la enfermedad del paciente.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e128 - e139"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47107146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：