Francisco Melibosky, Rene A. Jorquera, Felipe Z. Saxton, Pablo Orellana, Diego Junqueras, C. Azócar
Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest. The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers. The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze. The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s. Resumen Introducción La artrodesis de cuatro esquinas es una técnica para el tratamiento de colapsos avanzados del carpo. Consiste en realizar una escafoidectomía asociada a artrodesi
{"title":"Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study Artrodesis de cuatro esquinas con placa circular dorsal bloqueada versus tornillos canulados de compresión sin cabeza: estudio clínico-radiológico comparativo","authors":"Francisco Melibosky, Rene A. Jorquera, Felipe Z. Saxton, Pablo Orellana, Diego Junqueras, C. Azócar","doi":"10.1055/s-0041-1739239","DOIUrl":"https://doi.org/10.1055/s-0041-1739239","url":null,"abstract":"Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest. The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers. The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze. The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s. Resumen Introducción La artrodesis de cuatro esquinas es una técnica para el tratamiento de colapsos avanzados del carpo. Consiste en realizar una escafoidectomía asociada a artrodesi","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e105 - e114"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47273752","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}
R. K. Oliveira, S. Ribak, J. Brunelli, M. Aita, P. Delgado
Abstract Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment. The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology. When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability. We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD. Resumen La deformidad de Madelung (DM) comprende un aumento de la inclinación volar y cubital de la faceta articular del radio distal, secundaria a una displasia fisaria idiopática. Tal cambio causa un acortamiento radial y la consecuente prominencia cubital distal, junto con dolor en la muñeca y pérdida de movimiento. La cirugía se convierte en una opción en pacientes con deformidad severa que no responden al tratamiento conservador. Las técnicas quirúrgicas clásicas son problemáticas para los adultos, pues son específicas para niños y adolescentes, cuya fisis radial aún está abierta. Muy pocos artículos discuten el tratamiento de pacientes adultos; además, la mayoría se centra en la articulación radiocubital distal y, por tanto, no se acercan al origen de la patología. Al analizar la tomografía computarizada con reconstrucción tridimensional, se observa una característica de la DM, la detención del crecimiento de las porciones volar y cubital del radio distal, lo que provoca la deformidad típica del radio distal que conduce a la falta de cobertura del hueso semilunar. Eso conduce a una subluxación palmar del hueso semilunar y la consiguiente inestabilidad radiocarpiana. Decribimos en este artículo las posibilidades de tratamiento en distintas etapas de evolución, y resumimos las opiniones de los autores sobre la DM.
马德隆畸形(MD)包括桡骨远端关节面掌侧和尺侧倾斜增加，继发于特发性骨骺发育不良。这种改变导致桡骨缩短和随之而来的尺远端突出，同时伴有手腕疼痛和活动能力丧失。手术成为对保守治疗无效的严重畸形患者的一种选择。传统的手术技术对于成人来说是有问题的，因为它们是针对儿童和青少年的，他们的桡骨仍然是开放的。很少有论文讨论成人患者的治疗;此外，大多数集中在远端尺桡关节，因此没有接近病理的起源。当分析三维重建的计算机断层扫描时，MD的一个特征是桡骨远端掌侧和尺侧部分生长停止，引起典型的桡骨远端畸形，导致月骨覆盖不足。这导致掌月骨半脱位和随之而来的桡腕关节不稳定。我们在此描述了在不同发展阶段治疗的可能性，总结了作者对MD的看法。恢复La degenerad de Madelung (DM)理解unaumento de La inclinación掌侧/肘侧de La faceta关节del radio远端，second aria a una displasia idiopática。Tal cambio是由肘关节远端连续突出引起的，肘关节远端连续突出引起的，肘关节远端连续突出引起的，肘关节远端连续突出引起的。La cirugía se conconte在1月1日至1月1日期间，患者接受了多次治疗，但没有相应的治疗。Las tsamicnicas quirúrgicas clásicas son problemáticas para los adult, pues son específicas para niños y teens, cuya fisis radial aún estaberta。许多pocos artículos讨论了对患者成人的治疗;Además, la mayoría se centra en la articulación桡坐骨远端y, por tanto, no se acercan al origen de la patología。艾尔analizar la tomografia computarizada con reconstruccion立体的,se observa una caracteristica de la DM, la detencion del crecimiento de las porciones足底的y肘的del无线远端,lo, provoca la deformidad tipica del无线远端,有助la falta de cobertura del hueso半月形的。在此基础上进行了一项为期半年的研究(subluxación手掌模型)。Decribimos en este artículo提供了治疗的可能性，并提供了不同的治疗方法evolución，通过简历提供了治疗方法的可能性。
{"title":"Madelung Deformity: Diagnosis and Treatment Options Deformidad de Madelung: opciones de diagnóstico y tratamiento","authors":"R. K. Oliveira, S. Ribak, J. Brunelli, M. Aita, P. Delgado","doi":"10.1055/s-0041-1739452","DOIUrl":"https://doi.org/10.1055/s-0041-1739452","url":null,"abstract":"Abstract Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment. The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology. When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability. We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD. Resumen La deformidad de Madelung (DM) comprende un aumento de la inclinación volar y cubital de la faceta articular del radio distal, secundaria a una displasia fisaria idiopática. Tal cambio causa un acortamiento radial y la consecuente prominencia cubital distal, junto con dolor en la muñeca y pérdida de movimiento. La cirugía se convierte en una opción en pacientes con deformidad severa que no responden al tratamiento conservador. Las técnicas quirúrgicas clásicas son problemáticas para los adultos, pues son específicas para niños y adolescentes, cuya fisis radial aún está abierta. Muy pocos artículos discuten el tratamiento de pacientes adultos; además, la mayoría se centra en la articulación radiocubital distal y, por tanto, no se acercan al origen de la patología. Al analizar la tomografía computarizada con reconstrucción tridimensional, se observa una característica de la DM, la detención del crecimiento de las porciones volar y cubital del radio distal, lo que provoca la deformidad típica del radio distal que conduce a la falta de cobertura del hueso semilunar. Eso conduce a una subluxación palmar del hueso semilunar y la consiguiente inestabilidad radiocarpiana. Decribimos en este artículo las posibilidades de tratamiento en distintas etapas de evolución, y resumimos las opiniones de los autores sobre la DM.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e140 - e154"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41523740","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}
{"title":"How our Scientific Society Contributes to a Better World Cómo Nuestra Sociedad Científica Contribuye a un Mundo Mejor","authors":"A. Galán","doi":"10.1055/s-0041-1739308","DOIUrl":"https://doi.org/10.1055/s-0041-1739308","url":null,"abstract":"","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e89 - e89"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43180221","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}
D. Valverde-Vilamala, A. Sala-Pujals, J. Cebamanos, E. Dominguez-Font
Abstract Introduction Acrometastases are extremely rare in the hand, with a prevalence of around 0.1% according to the literature. They are normally associated with advanced tumor stages, especially in lung cancer. The present article shows the experience of our center in the management and treatment of these pathologies. Materials and Methods We report a series of 9 cases treated between 1992 and 2020 in the hand and wrist. Data regarding the primary tumor, the target organ, and survival are analyzed. A review of the cases of acrometastasis reported in the literature is also carried out, emphasizing in how many of then the acral lesion was the first sign of an unknown tumor. Results Acrometastases predominantly affect male patients aged around 60 years, and the primary tumor that is the cause in most cases is lung cancer, with a very low survival rate after the diagnosis (of approximately 8 months). Discussion and Conclusions In cases of acral lesion of non-traumatic origin, acrometastases should be considered, especially in patients who have a known primary tumor. In the present series, there were three cases in which the acrometastases were the first sign of a tumor in the patient, and in one of them it was initially treated as whitlow. In the literature, in approximately 50% of the cases, acrometastases are the first sign of the presence of a tumor. Once diagnosed, multidisciplinary medicosurgical treatment is essential to improve the patient's function and pain as much as possible. Resumen Introducción Las acrometástasis son extremadamente raras en la mano, con una prevalencia alrededor de un 0,1% según la literatura. Normalmente se asocian a patologías tumorales en estadios evolucionados, especialmente el carcinoma de pulmón. En este trabajo se muestra la experiencia de nuestro centro en el manejo y el tratamiento de estas entidades. Materiales y métodos Describimos una serie de 9 casos tratados entre 1992 y 2020 de acrometástasis en la mano y muñeca. Se analizan datos de tumor primario, órgano diana, tratamiento y supervivencia. Asimismo, se realiza una revisión de los casos de acrometástasis de la literatura, haciendo hincapié en cuántos de ellos la lesión acra fue el primer signo de patología tumoral desconocida. Resultados Se objetiva que afectan predominantemente a varones alrededor de 60 años, y que el tumor primario causante en la mayoría de los casos es el de pulmón, con una supervivencia del paciente tras el diagnóstico muy baja (alrededor de 8 meses). Discusión y conclusiones Ante una lesión acra de origen no traumático, hay que tener en cuenta las acrometástasis, especialmente en pacientes que tienen un tumor primario conocido. En esta serie hubo tres casos en los que las acrometástasis fueron el primer signo de la patología tumoral del paciente, y en uno de ellos se le trató erróneamente como un panadizo inicialmente. En la literatura, aproximadamente el 50% de las acrometástasis son el primer signo de patología tumoral.
肢端转移在手部极为罕见，据文献报道患病率约为0.1%。它们通常与晚期肿瘤有关，尤其是肺癌。本文将介绍本中心对这些疾病的处理和治疗经验。材料和方法我们报告了1992年至2020年期间手部和腕部治疗的9例病例。分析有关原发肿瘤、靶器官和生存率的数据。对文献报道的肢端转移病例也进行了回顾，强调有多少肢端病变是未知肿瘤的第一个迹象。结果肢端转移主要发生在60岁左右的男性患者，原发肿瘤多为肺癌，确诊后生存率极低(约8个月)。讨论与结论对于非外伤性肢端病变，应考虑肢端转移，特别是已知原发肿瘤的患者。在本系列中，有三个病例中，肢端转移是患者肿瘤的第一个迹象，其中一个病例最初被当作whitlow治疗。在文献中，大约50%的病例中，肢端转移是肿瘤存在的第一个迹象。一旦确诊，多学科的外科治疗是必要的，以改善患者的功能和疼痛尽可能多。简历Introducción Las acrometástasis son extremadamente raras en la mano, con una prevalencia alderderia de un 0,1% según la literature。正常基因与patologías肿瘤、尤其是恶性肿瘤(pulmón)有密切关系。在大学里，学生可以通过学习学习来体验大学生活，也可以通过学习学习来管理大学生活。说明1992年至2020年的第9系列贸易伙伴的资料(acrometástasis en la mano y muñeca)。原发肿瘤的分析数据，órgano diana，治疗和监护。Asimismo, se realizuna revisión de los casos de acrometástasis de la literature, haciendo hincapi en cuántos de los la lesión acra fute el primer signno de patología肿瘤desconciida。结果本研究的主要影响因素为已发生病变60例(años)，主要影响因素为肿瘤原发病因1例(mayoría)，已发生病变1例(pulmón)，已发生病变1例(diagnóstico)，已发生病变1例(8例)。Discusión y结论Ante una lesión acra de origen no traumático, hay que tener en cuenta las acrometástasis，特别是在肿瘤原发concono的患者中。En esta系列hubo树casos En los que las acrometástasis fueron el primer signno de la patología肿瘤del pacente, En uno ello se le trató erróneamente como un panadizo初步治疗。在现有文献中，约有50%的人认为acrometástasis是肿瘤的先导信号patología。在多学科的诊断和治疗中，我们的诊断和治疗是最基本的，我们的诊断和治疗是最基本的，我们的诊断和治疗是最基本的。
{"title":"Acrometastases to the Hand and Wrist: A Series of 9 Cases and Review of the Literature","authors":"D. Valverde-Vilamala, A. Sala-Pujals, J. Cebamanos, E. Dominguez-Font","doi":"10.1055/s-0042-1744260","DOIUrl":"https://doi.org/10.1055/s-0042-1744260","url":null,"abstract":"Abstract Introduction Acrometastases are extremely rare in the hand, with a prevalence of around 0.1% according to the literature. They are normally associated with advanced tumor stages, especially in lung cancer. The present article shows the experience of our center in the management and treatment of these pathologies. Materials and Methods We report a series of 9 cases treated between 1992 and 2020 in the hand and wrist. Data regarding the primary tumor, the target organ, and survival are analyzed. A review of the cases of acrometastasis reported in the literature is also carried out, emphasizing in how many of then the acral lesion was the first sign of an unknown tumor. Results Acrometastases predominantly affect male patients aged around 60 years, and the primary tumor that is the cause in most cases is lung cancer, with a very low survival rate after the diagnosis (of approximately 8 months). Discussion and Conclusions In cases of acral lesion of non-traumatic origin, acrometastases should be considered, especially in patients who have a known primary tumor. In the present series, there were three cases in which the acrometastases were the first sign of a tumor in the patient, and in one of them it was initially treated as whitlow. In the literature, in approximately 50% of the cases, acrometastases are the first sign of the presence of a tumor. Once diagnosed, multidisciplinary medicosurgical treatment is essential to improve the patient's function and pain as much as possible. Resumen Introducción Las acrometástasis son extremadamente raras en la mano, con una prevalencia alrededor de un 0,1% según la literatura. Normalmente se asocian a patologías tumorales en estadios evolucionados, especialmente el carcinoma de pulmón. En este trabajo se muestra la experiencia de nuestro centro en el manejo y el tratamiento de estas entidades. Materiales y métodos Describimos una serie de 9 casos tratados entre 1992 y 2020 de acrometástasis en la mano y muñeca. Se analizan datos de tumor primario, órgano diana, tratamiento y supervivencia. Asimismo, se realiza una revisión de los casos de acrometástasis de la literatura, haciendo hincapié en cuántos de ellos la lesión acra fue el primer signo de patología tumoral desconocida. Resultados Se objetiva que afectan predominantemente a varones alrededor de 60 años, y que el tumor primario causante en la mayoría de los casos es el de pulmón, con una supervivencia del paciente tras el diagnóstico muy baja (alrededor de 8 meses). Discusión y conclusiones Ante una lesión acra de origen no traumático, hay que tener en cuenta las acrometástasis, especialmente en pacientes que tienen un tumor primario conocido. En esta serie hubo tres casos en los que las acrometástasis fueron el primer signo de la patología tumoral del paciente, y en uno de ellos se le trató erróneamente como un panadizo inicialmente. En la literatura, aproximadamente el 50% de las acrometástasis son el primer signo de patología tumoral.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e19 - e26"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47186708","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 Despite the numerous techniques (both arthroscopic and open) for the treatment of acute scapholunate instability, there is no consensus on which one results in better healing of the ligaments. In the present work, we describe a new surgical technique to achieve stability of the scaphoid that enables the reduction inflexion and pronation of this bone when dissociation is produced. Using a high-strength suture wire with double cortical button anchor (Mini TightRope, Arthrex, Naples, FL, US, or MicroLink, Conmed, Largo, FL, US) stabilization of the scaphoid is achieved to protect ligament healing without the need for postoperative immobilization. Resumen A pesar de las numerosas técnicas (tanto artroscópicas como abiertas) para el tratamiento de la inestabilidad escafolunar aguda, no existe un consenso sobre cuál produce una mejor cicatrización ligamentosa. En este trabajo, presentamos una nueva técnica quirúrgica para conseguir una estabilización escafoidea que permita disminuir la flexión y la pronación del escafoides cuando se produce la disociación. Mediante un cable de sutura de alta resistencia con doble anclaje tipo botón cortical (Mini TightRope, Arthrex, Naples, FL, EEUU, o MicroLink, Conmed, Largo, FL, EEUU), se consigue una estabilización dinámica del escafoides para proteger la cicatrización ligamentosa sin necesidad de inmovilización postoperatoria.
{"title":"Scaphometacarpal Stabilization Technique for Repairable Scapholunate Injury","authors":"S. Pajares, J. Gómez-Álvarez, X. Sola-Mallo","doi":"10.1055/s-0042-1743279","DOIUrl":"https://doi.org/10.1055/s-0042-1743279","url":null,"abstract":"Abstract Despite the numerous techniques (both arthroscopic and open) for the treatment of acute scapholunate instability, there is no consensus on which one results in better healing of the ligaments. In the present work, we describe a new surgical technique to achieve stability of the scaphoid that enables the reduction inflexion and pronation of this bone when dissociation is produced. Using a high-strength suture wire with double cortical button anchor (Mini TightRope, Arthrex, Naples, FL, US, or MicroLink, Conmed, Largo, FL, US) stabilization of the scaphoid is achieved to protect ligament healing without the need for postoperative immobilization. Resumen A pesar de las numerosas técnicas (tanto artroscópicas como abiertas) para el tratamiento de la inestabilidad escafolunar aguda, no existe un consenso sobre cuál produce una mejor cicatrización ligamentosa. En este trabajo, presentamos una nueva técnica quirúrgica para conseguir una estabilización escafoidea que permita disminuir la flexión y la pronación del escafoides cuando se produce la disociación. Mediante un cable de sutura de alta resistencia con doble anclaje tipo botón cortical (Mini TightRope, Arthrex, Naples, FL, EEUU, o MicroLink, Conmed, Largo, FL, EEUU), se consigue una estabilización dinámica del escafoides para proteger la cicatrización ligamentosa sin necesidad de inmovilización postoperatoria.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e69 - e74"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43661267","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}
Rene A. Jorquera, Pablo Orellana, Francisco Melibosky, Eduardo Paz, R. Liendo, C. Azócar
Abstract Introduction Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others. Objective To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US). Materials and methods We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification. Results A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7. Conclusion Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months). Resumen Introducción La rizartrosis es una causa común de dolor y compromiso de la función de la mano. La mayoría de los pacientes responden de manera excelente al tratamiento conservador, aunque un pequeño porcentaje requieren algún tipo de procedimiento quirúrgico ante la persistencia de síntomas. Se han descrito diferentes procedimientos quirúrgicos; sin embargo, en la literatura aún no existe consenso respecto a la superioridad de una técnica sobre las demás. Objetivo Evaluar los resultados clínicos y radiológicos de pacientes con diagnóstico de rizartrosis, en estadios 2 a 3 de la clasificación de Eaton-Littler, operados con técnica de hemitrapezectomía artroscópica y suspensión con Mini TightRope (Arthrex, Naples, FL, EEUU). Materiales y métodos Se evaluaron retrospectivamente los resultados de pacientes
{"title":"Arthroscopic Hemitrapezectomy and Suspension with Mini TightRope for the Treatment of Rhizarthrosis: Outcome in patients in stages Eaton-Littler 2 to 3","authors":"Rene A. Jorquera, Pablo Orellana, Francisco Melibosky, Eduardo Paz, R. Liendo, C. Azócar","doi":"10.1055/s-0042-1743512","DOIUrl":"https://doi.org/10.1055/s-0042-1743512","url":null,"abstract":"Abstract Introduction Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others. Objective To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US). Materials and methods We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification. Results A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7. Conclusion Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months). Resumen Introducción La rizartrosis es una causa común de dolor y compromiso de la función de la mano. La mayoría de los pacientes responden de manera excelente al tratamiento conservador, aunque un pequeño porcentaje requieren algún tipo de procedimiento quirúrgico ante la persistencia de síntomas. Se han descrito diferentes procedimientos quirúrgicos; sin embargo, en la literatura aún no existe consenso respecto a la superioridad de una técnica sobre las demás. Objetivo Evaluar los resultados clínicos y radiológicos de pacientes con diagnóstico de rizartrosis, en estadios 2 a 3 de la clasificación de Eaton-Littler, operados con técnica de hemitrapezectomía artroscópica y suspensión con Mini TightRope (Arthrex, Naples, FL, EEUU). Materiales y métodos Se evaluaron retrospectivamente los resultados de pacientes","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e12 - e18"},"PeriodicalIF":0.0,"publicationDate":"2021-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45355812","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. Azócar, J. L. Cifras, Diego Montenegro, Tomás Barros, Hernán Jara, R. Liendo
Abstract Introduction The triangular fibrocartilage complex (TFCC) plays a fundamental role in the stability of the wrist, and its foveal insertion is the primary structure that performs this function. Surgical repair of the CFCT is challenging given the complexity of the anatomical structures, and arthroscopically-assisted reinsertion has shown certain benefits. The most commonly used techniques are reinsertion with anchors (RAs) and transosseous tunnels (TOs). Objective To compare the functional results of patients with acute foveal lesion of the CFCT operated through RAs versus TOs, both with arthroscopic assistance. Materials and methods A retrospective, observational study of patients operated on for foveal disinsertion of the TFCC. We included patients older than 18 years of age, with a traumatic history and conservative treatment lsting 3 months, with persistent pain and arthro-computed tomography (arthroCT) compatible with foveal disinsertion of the TFCC. Patients treated with the RA technique versus TOs were compared, both with arthroscopic assistance. The variables studied were pain during load according to the visual analog scale (VAS), Mayo score, and ranges of motion of the wrist. Values of p <0.05 were considered statistically significant. Results We included 24 patients (11 in the RAs group and 13 in the TOs group) With an average age of 28.5 years, 58% of whom were male, without statistically significant differences between the groups. In the whole sample, a decrease in pain of 4.33 points (standard deviation [SD]: 1.16) on the VAS was found, with no statistically significant differences between the groups (p = 0.98). The Mayo score improved in both groups, with an average of 30.09 points (SD: 0.94) in the RAs group, and 31.92 points (SD: 1.32) in the TOs group, and this difference was statistically significant ( p = 0.0004). Flexion-extension increased by 5.2° (SD: 2.3°) in the RAs group, and by 6.9° (SD: 1.32°) in the TOs group, and this difference was also statistically significant ( p = 0.01). Pronation improved by 15.9° (SD: 1.7°) in the RAs group, and by 15.8° (SD: 1.72°) in the TOs group, which was not statistically significant ( p = 0.46), and supination improved by 17.09° (SD: 2.46°) in the RAs group, and by 17.5° (SD: 1.61°) in the TOs group, which was statistically significant ( p = 0.004). The mean duration of ischemia was of 34.2 minutes (SD: 4.36 minutes) in the TOs group, and of 78.9 minutes (SD: 9.39 minutes) in the RAs group, and this difference was statistically significant ( p = 0.000). Discussion In the surgery for foveal reinsertion of the TFCC, both the techniques with anchors and with TOs, are effective in reducing load-bearing pain, improving the ranges of motion of the joints and the functional score. Although we found statistically significant differences between the groups regarding the Mayo score, flexion-extension and supination, these do not exceed the minimally-significant clinical differen
三角形纤维软骨复合体(TFCC)在腕关节的稳定中起着重要作用，其中央凹止点是实现这一功能的主要结构。考虑到解剖结构的复杂性，手术修复CFCT是具有挑战性的，关节镜辅助下的再插入显示出一定的好处。最常用的技术是锚钉再插入(RAs)和跨骨隧道(TOs)。目的比较关节镜辅助下经RAs与经TOs行急性中央凹CFCT手术的功能结果。材料与方法回顾性观察手术治疗TFCC中央凹脱位的患者。我们纳入了年龄大于18岁的患者，有创伤史，保守治疗3个月，持续疼痛，关节计算机断层扫描(artroct)与TFCC中央凹脱位相容。采用RA技术治疗的患者与采用TOs治疗的患者进行比较，均采用关节镜辅助。研究的变量是根据视觉模拟量表(VAS)、Mayo评分和手腕活动度来评估负荷疼痛。p <0.05为差异有统计学意义。结果纳入24例患者(RAs组11例，TOs组13例)，平均年龄28.5岁，男性占58%，组间差异无统计学意义。在整个样本中，VAS疼痛减轻4.33分(标准差[SD]: 1.16)，组间差异无统计学意义(p = 0.98)。两组患者Mayo评分均有改善，RAs组平均为30.09分(SD: 0.94)， TOs组平均为31.92分(SD: 1.32)，差异有统计学意义(p = 0.0004)。RAs组屈伸度增加5.2°(SD: 2.3°)，TOs组屈伸度增加6.9°(SD: 1.32°)，差异也有统计学意义(p = 0.01)。RAs组内旋改善15.9°(SD: 1.7°)，TOs组内旋改善15.8°(SD: 1.72°)，差异无统计学意义(p = 0.46); RAs组内旋改善17.09°(SD: 2.46°)，TOs组内旋改善17.5°(SD: 1.61°)，差异有统计学意义(p = 0.004)。TOs组平均缺血时间为34.2 min (SD: 4.36 min)， RAs组平均缺血时间为78.9 min (SD: 9.39 min)，差异有统计学意义(p = 0.000)。在TFCC中央凹再插入手术中，锚钉和TOs技术都能有效减轻负重疼痛，提高关节活动范围和功能评分。虽然我们发现两组之间在Mayo评分、屈伸和旋后方面存在统计学上的显著差异，但这些差异并不超过最小显著的临床差异。结论两种手法均能有效减轻负重疼痛，改善腕关节功能和活动度。TO手术缺血时间明显短于RA手术。Resumen Introducción El complexo fibrocartílago三角(CFCT)复合体unrol fundamental en la establidad de la muñeca, y su inserción foveal es la structurprimordial en esta función。“reparación quirúrgica del CFCT”和“desafío datada La complejidad de las structuras anatómicas”、“pollo que La reinserción conconsistencia artroscópica”和“mostrado ciertos beneficios”。Las t<s:1> cnicas más utilitzadas son la reinserción con anclaje óseo (RA) y con túneles transóseos (TOs)。目的:比较不同术者的功能差异(lesión)与不同术者(RA、TOs、ambos)之间的差异(artroscópica)。材料采用回顾性、观察性、临床操作方法研究desinserción CFCT中央凹。它们包括每个pacientesmayores de 18 años, contecedente traumático . manejo . msamicdico . 3 meses . evolución conpersistencia de dolor, artrotomografía . computarizada (artroTC)兼容的condesinserción . foveal del CFCT。我们比较了病人的病情和病人的病情与病人的病情，结果是一致的artroscópica。Las variables estudiadas fueron dolen carga según la escala visual análoga (EVA)， puntaje de Mayo, y rangos de moviididad de la muñeca。Se的考虑显著高于p < 0.05。结果共纳入24例患者(RA组11例，TOs组13例)，对照组28例，对照组5例(años)，对照组58%(男性)，差异有统计学意义(estadísticamente)。En toda la muestra, se encontró una disminución de 4,33 puntos (desviación estándar [de]: 1,16) En el putaje de la EVA，在两组中差异estadísticamente显著(p = 0,98)。El puntaje de Mayo mejoró en ambos grupos, con promedio de 30.09 puntos (de: 0,94); El grupo RA, y 31,92 puntos (de: 1)。 32) TOs组，差异有统计学意义(p = 0.0004)。RA组屈伸增加5.2°(从:2.3°)，TOs组屈伸增加6.9°(从:1.32°)，差异有统计学意义(p = 0.01)。旋于15,9改善:170°°()在RA组和15.8%°(:1,72°)在咳嗽,不很显著(p = 0,46)、内翻有所改善17.09°(:2,46°)RA和17.5°(组:1,61°)在咳嗽,这是显著的统计学差异(p = 0,004)。TOs组平均缺血时间为34.2分钟(4.36分钟)，RA组平均缺血时间为78.9分钟(9.39分钟)，差异有统计学意义(p = 0.000)。骨锚定和TOs在减少负重疼痛、改善关节范围和功能评分方面都是有效的。尽管我们发现两组之间在Mayo评分和屈伸和旋后方面存在统计学上的显著差异，但这些差异并不超过最小显著的临床差异。结论两种技术均能有效减轻负重疼痛，改善手腕功能和活动范围。ot手术的缺血时间明显短于ar手术。
{"title":"Arthroscopically-Assisted Foveal Repair of the Triangular Fibrocartilage Complex: Anchor Fixation versus Trans Osseous Tunnel – A Comparative Study","authors":"C. Azócar, J. L. Cifras, Diego Montenegro, Tomás Barros, Hernán Jara, R. Liendo","doi":"10.1055/s-0042-1742690","DOIUrl":"https://doi.org/10.1055/s-0042-1742690","url":null,"abstract":"Abstract Introduction The triangular fibrocartilage complex (TFCC) plays a fundamental role in the stability of the wrist, and its foveal insertion is the primary structure that performs this function. Surgical repair of the CFCT is challenging given the complexity of the anatomical structures, and arthroscopically-assisted reinsertion has shown certain benefits. The most commonly used techniques are reinsertion with anchors (RAs) and transosseous tunnels (TOs). Objective To compare the functional results of patients with acute foveal lesion of the CFCT operated through RAs versus TOs, both with arthroscopic assistance. Materials and methods A retrospective, observational study of patients operated on for foveal disinsertion of the TFCC. We included patients older than 18 years of age, with a traumatic history and conservative treatment lsting 3 months, with persistent pain and arthro-computed tomography (arthroCT) compatible with foveal disinsertion of the TFCC. Patients treated with the RA technique versus TOs were compared, both with arthroscopic assistance. The variables studied were pain during load according to the visual analog scale (VAS), Mayo score, and ranges of motion of the wrist. Values of p <0.05 were considered statistically significant. Results We included 24 patients (11 in the RAs group and 13 in the TOs group) With an average age of 28.5 years, 58% of whom were male, without statistically significant differences between the groups. In the whole sample, a decrease in pain of 4.33 points (standard deviation [SD]: 1.16) on the VAS was found, with no statistically significant differences between the groups (p = 0.98). The Mayo score improved in both groups, with an average of 30.09 points (SD: 0.94) in the RAs group, and 31.92 points (SD: 1.32) in the TOs group, and this difference was statistically significant ( p = 0.0004). Flexion-extension increased by 5.2° (SD: 2.3°) in the RAs group, and by 6.9° (SD: 1.32°) in the TOs group, and this difference was also statistically significant ( p = 0.01). Pronation improved by 15.9° (SD: 1.7°) in the RAs group, and by 15.8° (SD: 1.72°) in the TOs group, which was not statistically significant ( p = 0.46), and supination improved by 17.09° (SD: 2.46°) in the RAs group, and by 17.5° (SD: 1.61°) in the TOs group, which was statistically significant ( p = 0.004). The mean duration of ischemia was of 34.2 minutes (SD: 4.36 minutes) in the TOs group, and of 78.9 minutes (SD: 9.39 minutes) in the RAs group, and this difference was statistically significant ( p = 0.000). Discussion In the surgery for foveal reinsertion of the TFCC, both the techniques with anchors and with TOs, are effective in reducing load-bearing pain, improving the ranges of motion of the joints and the functional score. Although we found statistically significant differences between the groups regarding the Mayo score, flexion-extension and supination, these do not exceed the minimally-significant clinical differen","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e3 - e11"},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41742185","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. Aita, Ricardo Kaempf, B. Biondi, G. A. Montano, Fernando Towata, G. Rodriguez, G. M. Ruggiero
Abstract Articular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly. Resumen Las fracturas articulares del radio distal han aumentado su incidencia en los últimos años, especialmente en la población económicamente activa. La mayoría de las veces el tratamiento se basa en radiografías simples y no nos dan ninguna información sobre cómo tratar estas fracturas. En la búsqueda por soluciones con mayor precisión en el diagnóstico, en la reducción de la superficie articular de la fractura, y con técnicas mínimamente invasivas, encontramos la artroscopia como la principal herramienta para estos pacientes. Por lo tanto, una mejor comprensión biomecánica de los diferentes tipos de fracturas asociadas a las lesiones de ligamentos debería facilitar la decisión correcta de tratamiento. Este artículo tiene como objetivo proporcionar un concepto orientado al tratamiento para el manejo de las lesiones ligamentarias asociadas a las fracturas intraarticulares del radio distal basado en un procedimiento asistido por artroscopia, y mostrar los resultados objetivos y reportados por el paciente y una nueva clasificación. Los resultados objetivos y reportados por el paciente fueron: el rango de movim
{"title":"Arthroscopic Management of Intra-articular Ligament Lesions on Distal Radius Fractures Manejo artroscópico de lesiones de ligamentos intraarticulares en fracturas del radio distal","authors":"M. Aita, Ricardo Kaempf, B. Biondi, G. A. Montano, Fernando Towata, G. Rodriguez, G. M. Ruggiero","doi":"10.1055/s-0041-1730393","DOIUrl":"https://doi.org/10.1055/s-0041-1730393","url":null,"abstract":"Abstract Articular distal radius fractures (DRFs) have increased in incidence in recent years, especially among the economically active population. Most of the treatment approaches are based on plain X- rays, and do not give us any information on how to treat these fractures. In the search for solutions with greater precision in diagnosis, in reducing the joint surface of the fracture, and envolving minimally-invasive techniques, we found arthroscopy as the main tool for these patients. Therefore, an enhanced understanding of the biomechanics of the different types of fracture associated with ligamentous lesions should facilitate the right decision regarding the treatment. The present paper aims at providing a management-oriented concept to diagnose and treat ligamentous lesions associated with intra-articular DRFs based on a arthroscopy-assisted procedure, and showing the objective and patient-reported outcomes and a new classification. The objective and patient-reported outcomes were: the mean range of motion (ROM) was of 94.80% on the non-affected side; the mean score on the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) was of 3.6 (range: 1 to 12). The score on the Visual Analog Scale (VAS) was of 1.66 (range: 1 to 3). Complications were observed in 2 (13.33%) patients: extensor tendon synovitis in 1 patient, and a limitation (stiffness) in ROM in 1 patient, both treated with wrist arthroscopy release. The mean time until the return to work was of 6.4 weeks. In patients with unstable intra-articular DRFs associated with ligamentous lesions, the fixation of specific osseous-ligamentous fragments and ligamentous repair/reconstruction by wrist arthroscopy prove to be a safe and reliable treatment. The clinical and functional results predict that the patients can return to work more quickly. Resumen Las fracturas articulares del radio distal han aumentado su incidencia en los últimos años, especialmente en la población económicamente activa. La mayoría de las veces el tratamiento se basa en radiografías simples y no nos dan ninguna información sobre cómo tratar estas fracturas. En la búsqueda por soluciones con mayor precisión en el diagnóstico, en la reducción de la superficie articular de la fractura, y con técnicas mínimamente invasivas, encontramos la artroscopia como la principal herramienta para estos pacientes. Por lo tanto, una mejor comprensión biomecánica de los diferentes tipos de fracturas asociadas a las lesiones de ligamentos debería facilitar la decisión correcta de tratamiento. Este artículo tiene como objetivo proporcionar un concepto orientado al tratamiento para el manejo de las lesiones ligamentarias asociadas a las fracturas intraarticulares del radio distal basado en un procedimiento asistido por artroscopia, y mostrar los resultados objetivos y reportados por el paciente y una nueva clasificación. Los resultados objetivos y reportados por el paciente fueron: el rango de movim","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"024 - 036"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1730393","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42249847","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}
{"title":"A New ILA Congress: Towards a New Reality Un Nuevo Congreso del ILA: Hacia una Nueva Realidad","authors":"Ricardo Kaempf, Raimundo Araújo Filho, P. Delgado","doi":"10.1055/s-0041-1730395","DOIUrl":"https://doi.org/10.1055/s-0041-1730395","url":null,"abstract":"","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"001 - 003"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1730395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48691250","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}
Ryan C. Xiao, Carl M. Cirino, Christine S. Williams, Michael Hausman
Abstract As surgeons have become more familiar with elbow arthroscopy, the indications for arthroscopy of the pediatric elbow have expanded to include contracture releases, fracture fixation, treatment of osteochondritis dissecans (OCD) lesions, correction of elbow deformity, and debridement of soft tissue and bony pathologies. The treatment of various pathologies via an arthroscopic approach demonstrates equal, if not better, efficacy and safety as open surgery for the pediatric elbow. Arthroscopy provides the unique advantage of enabling the performance of extensive surgeries through a minimally-invasive approach, and it facilitates staged interventions in cases of increased complexity. For fracture work, arthroscopy enables direct visualization to assess reduction for percutaneous fixations. While future research is warranted to better evaluate the indications and outcomes of pediatric elbow arthroscopy, this update article presents a review of the current literature, as well as several innovative cases highlighting the potential of arthroscopy. Resumen A medida que los cirujanos se han familiarizado con la artroscopia del codo, las indicaciones para la artroscopia del codo pediátrico se han ampliado para incluir la liberación de contracturas, la fijación de fracturas, el tratamiento de lesiones de osteocondritis disecante (OCD), la corrección de la deformidad del codo, y el desbridamiento de patologías óseas y de tejidos blandos. El tratamiento de diversas patologías mediante un abordaje artroscópico demuestra la misma eficacia y seguridad, si no mejor, que la cirugía abierta del codo pediátrico. La artroscopia proporciona la ventaja única de permitir la realización cirugías extensas a través de un abordaje mínimamente invasivo, y facilita las intervenciones por etapas en casos de mayor complejidad. Para las fracturas, la artroscopia permite la visualización directa para evaluar la reducción de las fijaciones percutáneas. Si bien se justifica la investigación futura para evaluar mejor las indicaciones y los resultados de la artroscopia del codo pediátrico, este artículo de actualización presenta una revisión de la literatura actual y varios casos innovadores que destacan el potencial de la artroscopia.
随着外科医生对肘关节镜检查的熟悉，儿童肘关节镜检查的适应症已经扩大到包括挛缩松解、骨折固定、剥脱性骨软骨炎(OCD)病变的治疗、肘关节畸形的矫正以及软组织和骨骼病变的清创。通过关节镜入路治疗各种病症与儿童肘关节开放手术的疗效和安全性相同，甚至更好。关节镜提供了独特的优势，可以通过微创方法进行广泛的手术，并且可以在复杂性增加的情况下进行分阶段干预。对于骨折工作，关节镜可以直接可视化评估经皮固定复位。虽然未来的研究需要更好地评估儿童肘关节镜检查的适应症和结果，但这篇更新的文章回顾了当前的文献，以及几个突出关节镜检查潜力的创新案例。Resumen洛cirujanos se medida是汉族familiarizado con la artroscopia德尔科多兽,拉斯维加斯indicaciones对位拉artroscopia德尔科多兽pediatrico se汉ampliado对位incluir紧接着de contracturas洛杉矶成为de fracturas及德病变de osteocondritis disecante(强迫症),洛杉矶correccion de la deformidad德尔科多兽,y el desbridamiento de patologias伊顺y de tejidos blandos。El tratamiento de diverdaje patologías mediante unabordaje artroscópico demuestra la misma eficacia y security, si no major, que la cirugía abierta del codo pediátrico。关节镜观察术(La trotroscopia proporciona La ventaja única de permitir La realización cirugías)、关节镜观察术(transacos)、关节镜观察术(transacos)、关节镜观察术(transacos)、关节镜观察术(transacos)、关节镜观察术(transacos)、关节镜观察术(transacos)、关节镜观察术(acos)、关节镜观察术(acos)、关节镜观察术(acos)。Para as骨折，la artroscopy permit la visualización directa Para evaluar la reducción de las fijaciones percutáneas。在不同的情况下，我们的研究结果证明了我们的研究结果是正确的，我们的研究结果是正确的，我们的研究结果是正确的，我们的研究结果是正确的，我们的研究结果是正确的，我们的研究结果是正确的，我们的研究是正确的。
{"title":"Arthroscopy of the Pediatric Elbow: Review of the Current Concepts Artroscopia del codo pediátrico: revisión de los conceptos actuales","authors":"Ryan C. Xiao, Carl M. Cirino, Christine S. Williams, Michael Hausman","doi":"10.1055/s-0041-1730394","DOIUrl":"https://doi.org/10.1055/s-0041-1730394","url":null,"abstract":"Abstract As surgeons have become more familiar with elbow arthroscopy, the indications for arthroscopy of the pediatric elbow have expanded to include contracture releases, fracture fixation, treatment of osteochondritis dissecans (OCD) lesions, correction of elbow deformity, and debridement of soft tissue and bony pathologies. The treatment of various pathologies via an arthroscopic approach demonstrates equal, if not better, efficacy and safety as open surgery for the pediatric elbow. Arthroscopy provides the unique advantage of enabling the performance of extensive surgeries through a minimally-invasive approach, and it facilitates staged interventions in cases of increased complexity. For fracture work, arthroscopy enables direct visualization to assess reduction for percutaneous fixations. While future research is warranted to better evaluate the indications and outcomes of pediatric elbow arthroscopy, this update article presents a review of the current literature, as well as several innovative cases highlighting the potential of arthroscopy. Resumen A medida que los cirujanos se han familiarizado con la artroscopia del codo, las indicaciones para la artroscopia del codo pediátrico se han ampliado para incluir la liberación de contracturas, la fijación de fracturas, el tratamiento de lesiones de osteocondritis disecante (OCD), la corrección de la deformidad del codo, y el desbridamiento de patologías óseas y de tejidos blandos. El tratamiento de diversas patologías mediante un abordaje artroscópico demuestra la misma eficacia y seguridad, si no mejor, que la cirugía abierta del codo pediátrico. La artroscopia proporciona la ventaja única de permitir la realización cirugías extensas a través de un abordaje mínimamente invasivo, y facilita las intervenciones por etapas en casos de mayor complejidad. Para las fracturas, la artroscopia permite la visualización directa para evaluar la reducción de las fijaciones percutáneas. Si bien se justifica la investigación futura para evaluar mejor las indicaciones y los resultados de la artroscopia del codo pediátrico, este artículo de actualización presenta una revisión de la literatura actual y varios casos innovadores que destacan el potencial de la artroscopia.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"056 - 065"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1730394","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45231266","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}
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