A Importância dos Métodos de Determinação das Idades Esquelética e Dentária na Ortodontia e Odontopediatria ­ uma Revisão de Literatura / The Importance of Methods for Determination of Squeletal and Dental Age in Orthodontics and Pediatric Dentistry ­ a Literature Review

O estágio de desenvolvimento humano é intimamente relacionado à sua maturidade óssea ou dentária, sendo essencial para a escolha do tratamento de alterações dentofaciais em crianças e adolescentes por ortodontistas e odontopediatras. Existem diversos indicadores biológicos para determinar a maturação do indivíduo, como a idade cronológica e as alterações hormonais, porém esses indicadores podem sofrer interferências. Visando uma determinação de desenvolvimento e dos picos de crescimento mais precisa, para um melhor diagnóstico e plano de tratamento, foram desenvolvidos diversos métodos para determinar a idade esquelética e a idade dentária, sendo estes a avaliação da maturação carpal, da morfologia das vértebras cervicais, da fusão óssea da sincondrose esfeno-occipital e da sutura palatina mediana, bem como dos estágios da calcificação dentária. A avaliação das radiografias de mão e punho é o padrão ouro da predição da idade esquelética, e sua correlação com outros métodos já é evidente. Sendo assim, é possível utilizar a avaliação das vértebras cervicais e das idades dentárias de Nolla e Demirjian.

The stage of human development is closely related to bone or dental maturity, being essential for the choice of treatment for dentofacial changes in children and adolescents by orthodontists and pediatric dentists. There are several biological indicators to determine an individual's maturation, such as chronological age and hormonal changes, but these indicators can suffer interference. Aiming at a more accurate determination of development and growth peaks, for a better diagnosis and treatment plan, several methods have been developed to determine skeletal age and dental age, these being the assessment of carpal maturation, the morphology of the cervical vertebrae, bone fusion of the spheno-occipital synchondrosis and the median palatal suture, as well as the stages of dental calcification. The evaluation of hand and wrist radiographs is the gold standard for predicting skeletal age, and its correlation with other methods is already evident. Therefore, it is possible to use the assessment of cervical vertebrae and dental ages by Nolla and Demirjian.

Isolated distal pisiform dislocation: Case Report / Luxação distal isolada do pisiforme: Relato de caso

Abstract Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction.

Resumo A luxação isolada do pisiforme é uma lesão rara com poucos casos descritos na literatura. Esse tipo de lesão é observado tipicamente em adultos jovens do sexo masculino e pode ser facilmente negligenciada numa primeira avaliação. A luxação proximal isolada é mais comum devido à ação do flexor ulnar do carpo (FUC). Apresentamos o caso de um paciente do sexo masculino, com 19 anos de idade, com luxação distal isolada do pisiforme após traumatismo do punho. O paciente foi submetido a uma redução aberta e fixação interna com fios de Kirschner com excelente resultado funcional. Apesar de não existir um método de tratamento consensual, a redução fechada perfila-se como tratamento de primeira linha na apresentação aguda. Em caso de insucesso ou como método alternativo pode-se optar pela redução aberta ou a excisão do pisiforme.

Radiocarpal fracture dislocations: a new classification and treatment proposal / Fratura-luxação radiocárpica: nova classificação e proposta de tratamento

ABSTRACT Introduction The radiographic and surgical findings, and treatment of radiocarpal fracture dislocations, were analyzed retrospectively in 40 patients. Materials and Methods All patients were classified according to Dumontier´s radiological classification and compared with the surgical findings. Based on this analysis, a new classification and treatment are proposed. Results From 1995 to 2018, 40 patients with radiocarpal fracture dislocation underwent surgery. Thirty-six were males and four were females. The mean age was twenty-four years (range: 18-45). Three dislocations were volar dislocations and 37 were displaced dorsally. Initially, 8 (20%) patients were classified as group I, 29 (72.5%) as group II, and 3 (7.5%) remained unclassified. The main variations occurred in group II. Seven fractures were stable after radial styloid fixation and 6 remained unstable. Sixteen fractures presented articular fragments or an interposed capsule, which prevented anatomical reduction using conservative maneuvers. Conclusion Based in our intraoperative observations and surgical results, we believe that a more detailed classification should be adopted. Level of Evidence IV; Therapeutic Studies; Case Series.

RESUMO Introdução Os achados radiográficos, cirúrgicos e o tratamento das fraturas-luxações radiocárpicas foram analisados retrospectivamente em 40 pacientes. Materiais e Métodos Todos os pacientes foram classificados de acordo com a classificação radiológica de Dumontier e comparados com os achados cirúrgicos. Com base nessa análise, uma nova classificação e tratamento são propostos. Resultados De 1995 a 2018, 40 pacientes com fratura-luxação radiocárpica foram submetidos à cirurgia. Trinta e seis eram homens e quatro mulheres. A média de idade foi de vinte e quatro anos (variação de 18 a 45). Três luxações eram volares e 37 dorsais. Inicialmente, 8 (20%) pacientes foram classificados como Grupo I, 29 (72,5%), como Grupo II e 3 (7,5%), permaneceram sem classificação. As variações principais ocorreram no Grupo II. Sete fraturas permaneceram estáveis depois da fixação da estiloide radial e 6 permaneceram instáveis. Dezesseis fraturas apresentaram fragmentos articulares ou cápsula interposta que impediu a redução anatômica por manobras conservadoras. Conclusões Com base em nossas observações intraoperatórias e nos resultados cirúrgicos, acreditamos que uma classificação mais detalhada deva ser adotada. Nível de evidência IV;Estudos Terapêuticos; Série de casos.

Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays / Índice de falha diagnóstica na detecção de fraturas e luxações perilunares do carpo utilizando radiografias simples do punho

Abstract Objectives The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis. Methods An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs. Results A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%). Conclusion Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.

Resumo Objetivos O presente estude teve como objetivo avaliar o índice de falha diagnóstica na detecção de fraturas e luxações perilunares do carpo utilizando radiografias simples do punho por ortopedistas e residentes de ortopedia. Secundariamente, identificar possíveis grupos que apresentem maior ou menor chance de acerto diagnóstico. Métodos Foi aplicado um questionário online a diversos ortopedistas através de e-mail, redes sociais e aplicativos de comunicação via smartphone, para avaliar o índice de falha diagnóstica na detecção de fraturas e luxações perilunares utilizando radiografias simples. Resultados Foram obtidas 511 respostas e observado um índice de erro diagnóstico de 8,81% para as luxações simples e 1,76% para fratura transescafoperilunar. Ao estratificar por grupos, os médicos residentes obtiveram os maiores índices de erro nas luxações perilunares simples (23,91%), já os cirurgiões de mão obtiveram os índices mais baixos (1,74%). Conclusão Ao comparar com a literatura, os índices de falha encontrados foram menores, sugerindo que a radiografia simples é eficaz e que o índice de erro pode não ser tão elevado quanto o relatado na literatura.

Osteoma osteoide: causa poco frecuente de dolor crónico en la muñeca en una niña / Osteoid osteoma: unusual cause of chronic pain in the wrist in a child

El osteoma osteoide es una lesión ósea benigna que, habitualmente, se acompaña de clínica típica caracterizada por dolor nocturno que mejora con antiinflamatorios no esteroideos. Aunque la presentación clínica es típica, con frecuencia, es común la demora diagnóstica, en especial, en los casos con localización atípica.Se presenta el caso de una paciente de 10 años con dolor en la muñeca izquierda de dos años de evolución con diagnóstico de osteoma osteoide localizado en el hueso grande del carpo. La localización atípica de la lesión conllevó un retraso diagnóstico importante

Osteoid osteoma is a benign bone lesion that is usually accompanied by a typical clinical condition characterized by night pain that improves with non-steroidal anti-inflammatory drugs. Although the clinical presentation is frequently typical, diagnostic delay is common, especially in cases with an atypical location.We report the case of a 10-year-old patient with left wrist pain of two years of evolution with diagnosis of osteoid osteoma located in capitate bone. The atypical location of the lesion led to a significant diagnostic delay.

Identification of dental calcification stages as a predictor of skeletal development phase

ABSTRACT Objective: This study aimed to establish a correlation between the stages of tooth calcification of mandibular canines and second molars with the phases of skeletal development. Methods: In a consecutive series of panoramic, cephalometric and hand-wrist radiographs of 113 individuals (60 females and 53 males) with an average age of 12.24 ± 1.81 years, the stages of mandibular canine and second molar calcification, cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI) were classified. The variables were correlated by means of the Spearman's Rank test: chronological age, SMI, CVMI and tooth calcification stages. In order to assess whether the CVMI and tooth calcification stages were significant predictors of the SMI, an ordinal regression analysis was carried out. Results: The stages of CVMI (OR = 16.92; CI 95% = 6.45-44.39; p< 0.001) and calcification of the second molars (OR = 3.22; CI 95% = 1.50-6.92; p= 0.003) were significant predictors of SMI, however similar result was not observed for canines (OR = 0.52, CI 95% = 0.18-1.54; p= 0.239). Calcification stage E for boys, and E and F for girls corresponded to the pre-peak phase of pubertal growth. Stages G and H for boys, and F and G for girls coincided with peak of growth. In the final growth phase, the majority of second molars presented with root apex closure (stage H). Conclusion: The stages of calcification of the second molar may be considered predictors of the stage of skeletal development in the population studied.

RESUMO Objetivo: O presente estudo objetivou estabelecer uma correlação entre os estágios de calcificação dentária de caninos e segundos molares inferiores e as fases do desenvolvimento esquelético. Métodos: Em uma série consecutiva de radiografias panorâmicas, cefalométricas e de mão e punho de 113 indivíduos (60 meninas e 53 meninos) com idade média de 12,24 ± 1,81 anos, foram classificados os estágios de calcificação do canino e do segundo molar inferiores, indicadores de maturação das vértebras cervicais (IMVC) e indicadores de maturação esquelética (IME). As variáveis foram correlacionadas pelo teste de Correlação de Rank de Spearman: idade cronológica, IME, IMVC e estágios de calcificação dentária. A fim de avaliar se os estágios do IMVC e da calcificação dentária foram preditores significativos do IME, foi realizada uma análise de regressão ordinal. Resultados: Os estágios de IMVC (OR = 16,92; IC 95% = 6,45-44,39; p< 0,001) e calcificação dos segundos molares (OR = 3,22; IC 95% = 1,50-6,92; p= 0,003) foram preditores significativos de IME; no entanto, esse não foi o caso com dentes caninos (OR = 0,52, IC 95% = 0,18-1,54; p= 0,239). Os estágios de calcificação E para meninos e E e F para meninas corresponderam à fase pré-pico de crescimento puberal. Os estágios G e H para meninos e F e G para meninas coincidiram com o pico de crescimento. Na fase final de crescimento, a maioria dos segundos molares apresentou fechamento do ápice radicular (estágio H). Conclusão: Os estágios de calcificação do segundo molar podem ser considerados preditores do estágio de desenvolvimento esquelético na população estudada.

Fratura fisária do rádio e luxação perilunar do carpo: um relato de caso / Physeal fracture of radius and perilunate dislocation of carpo: a case report

A relevância do relato de caso em questão está em sua raridade de acometimento durante a infância (período em que se observa um sinal clássico em uma das radiografias solicitadas). Trata-se de uma luxação perilunar em punho direito, associada à fratura fisária do rádio em criança de onze anos, após acidente com laço. Foi feita a redução fechada e colocação de tala gessada no membro, o qual também apresentava áreas de sofrimento da pele causadas pela corda. O quadro clínico do paciente evoluiu com dor, edema e diminuição da perfusão. Nesse momento, foi encaminhado para o centro cirúrgico onde foi realizada redução aberta com incisão dorsal em S, fixação da luxa-ção e fasciotomia. Após o ato cirúrgico, paciente evoluiu bem. Atualmente, após algumas sessões de fisioterapia, tem movimento quase total de flexão e extensão do punho, restando apenas limitação no desvio ulnar e radial. As crianças do século XXI se mostram muito ativas em vista disso têm aumentado os casos de fratura e luxação na pediatria, tanto pelo aumento do impacto quanto pela exposição a possíveis mecanismos de lesão. (AU)

The relevance of this case report is its rarity of involvement during childhood (the period in which there is a classic sign in one of the required x-rays). This is a case of perilunate dislocation in right wrist associated with physeal fracture of radius in an eleven-year-old child, after a rope accident. The closed reduction and placement of a plas-ter splint were performed, which also presented areas of skin suffering caused by the rope. The patient's medical condition evolved for pain, edema, and decreased perfusion. At that time, he was transferred to a surgical center where it was performed an open reduction with a dorsal incision in S, dislocation fixation and fasciotomy. After the surgical procedure, the patient's medical condition developed well. Currently, after some physical therapy sessions, he has almost total movement of flexion and extension of his wrist, there is the only limitation in ulnar and radial deviation. Children of the 21st century are very active, and there has been an increase in the cases of fracture and dislocation, in pediatrics, both by increasing impact and exposure to possible mechanisms of injury (AU)

A Prospective Study to Appearances of Ossification Centers in the Carpal Bones in Girls of Age Group 5 Years to 12 Years in Western Rajasthan Jodhpur Region

Background: Age estimation in living as well as dead is one ofthe most important task for a forensic practitioner. Verificationor determination of age is prerequisite for personalidentification in living as well as dead. In the present studyestimation of age in the individual of age varying between 5year to 12 years will, be conducted using the appearance ofossification of carpal bones in girls of the western Rajasthan(Jodhpur) region.Materials & Methods: The radiological prospective study of“appearances of ossification centers in the carpal bones in girlsof age group 5 years to 12 years in western Rajasthan jodhpurregion" was conducted in western Rajasthan jodhpur regionstudying in various schools of jodhpur district. The childrenwere selected for the study in the age group of 5 to12 yearsand are from the girls. All observation was noted on a commonstandard proforma and later the findings will tabulated to drawnecessary conclusion.Results: We found that triquetral appeared at age of 3-4 yearsand lunate at the age of 4-5 years. Trapezium, trapezoid andscaphoid carpals appeared between the age of 5 to 9 years.Conclusion: We concluded that Triquetral and lunate carpalsappear after capitate and hamate. Their appearance wasslightly earlier in females than in males.

Artificial intelligence system for assessment of children carpal bone age / 中国医学影像技术

Objective: To observe the clinical feasibility of carpal bone age assessment (BAA) using artificial intelligence (AI) system. Methods: Totally 130 hand-wrist radiographs of children aged 1-13 years were retrospectively studied. Carpal bone ages estimated by three senior radiologists were taken as reference standards. The root mean square error (RMSE) and mean absolute error (MAE) of carpal bone age estimations and carpal maturity scores relative to the reference standard were calculated and compared between AI system (model) and 3 junior radiologists (physician 1, 2, 3), respectively. The intraclass correlation coefficient (ICC) was used to test the agreement of BAA among the model, physicians and reference standards. BAA time was also compared between model and physicians, respectively. Results: There were significant differences of carpal BAA's MAE and RMSE of model and physician 1, 2 (all P0.05). There were significant differences of carpal maturity score's MAE and RMSE between model and physicians 1 (both P0.05). ICC between BAA of AI and reference standards was 0.997, between physician 1, 2, 3 and reference standards was 0.994, 0.996 and 0.997, respectively. BAA time of AI was significantly shorter than that of three physicians (all P<0.05). Conclusion: Using AI BAA system can fast estimate carpal bone age with high accuracy.

Trans-scaphoid perilunate fracture dislocation beyond Mayfield stage IV: a case report on a new classification proposal / Fratura luxação transescafoperissemilunar além do estágio IV de Mayfield. Estudo preliminar. Proposta de nova classificação: relato de caso

ABSTRACT This report and review of the literature aims to recognize the complete enucleation beyond stage IV of the classification proposed by Mayfield. The addition of a fifth category is proposed, added for complete ligament injuries that lead to nonexistent circulation for the radiolunate ligament, preventing surgical reconstruction, thus influencing surgical treatment.

RESUMO Esse relato e revisão na literatura tem como objetivo reconhecer a enucleação total além do estágio IV da classificação proposta por Mayfield. Propõe-se a adição de uma quinta categoria, para lesões ligamentares completas que levam a uma circulação inexistente do ligamento radiolunar, impedem a reconstrução cirúrgica e influenciam, assim, o tratamento cirúrgico.

Study of Carpal Bone Ossification by Using Radiological Method for Age Estimation of Infant and Paediatric Group in North Indian Population

Background: Ossification of carpal bones forms the most significant aspect of development in clinical sciences and in medical jurisprudence. Important factors influencing the process of ossification include age, sex, heredity, the state of nourishment and particular geographical region may not be exactly similar to that in another area. The main purpose of this study is to evaluate the average age of appearance of the ossification centre of Indian population in comparison with western data. Materials & Methods: Present work was performed in 200 healthy individual of both sexes of which  date of birth proof was present .  X-ray of carpal bones were taken for presence or absence of centre of ossification of the individual carpal bones. Results: In the present study 102(51%)males  and 98 (49%) females  were taken who had accurate birth certificate indicating their age from  < 6 month to 12 year. Variation in the appearance of centre of ossification in carpal bones shows influence of race, climate, nutritional, and geographical factors. Conclusion: Ossification of carpal bones  in the population of North India occur 1-2 year later then  Europeans and  appearance of the ossification centre is earlier in females  than males .

Stress Fracture of the Capitate

Most capitate fractures occur in association with additional carpal injuries, particularly scaphoid fractures. Isolated fractures of the capitate account for only 0.3% of carpal injuries, and stress fractures are one form of this fracture. We report the case of a 20-year-old male who had a stress fracture of the capitate after serving as an honor guard in the military. Conventional radiographs and computed tomography of the right wrist revealed a minimally displaced fracture line located at the midcarpal aspect of the right capitate. A magnetic resonance imaging scan demonstrates a subarticular capitate fracture with diffuse bone marrow edema, small osteophytes, and irregularity of the midcarpal articular cartilage. We also review the carpal kinematics which possibly caused the stress fracture. Although stress fractures of the capitate are rare, they should also be accounted for with patients who perform repetitive motions of the wrist to a considerable extent.

Perilunate carpal dislocation. Clinical evaluation of patients operated with reduction and percutaneous fixation without capsular-ligament repair / Luxação perilunar do carpo. Avaliação clínica de casos operados com redução e fixação percutânea, sem reparo cápsulo-ligamentar

ABSTRACT OBJECTIVE: To qualitatively assess surgeries performed in patients with perilunate dislocations without associated fractures, who were operated using the closed reduction and percutaneous fixation method. The follow-up time ranged from one to seven years. METHODS: 628 patient records with traumatic wrist injuries, operated by the same group of Hand Surgeons between 2008 and 2014 due to acute trauma were collected, with a mean follow-up of 3.2 years. Of these, 51 were cases of perilunate fracture-dislocations, and 38 were pure perilunate dislocations without associated fractures; of these, only 32 underwent percutaneous fixation without ligamentous repair, thus meeting the inclusion criteria. Of the nine patients with perilunate dislocations who were treated using the closed reduction and percutaneous fixation method, whose mean age was 38 years (range 26-49 years), the dominant side was the left in two-thirds of the cases, and the predominant trauma mechanism was direct trauma. RESULTS: This study is in agreement with the literature, showing that cases treated early present good results. CONCLUSION: 88% of patients who were treated by closed reduction and percutaneous fixation method maintained their daily activities and were assessed as excellent or good by the Clinical Scoring Chart.

RESUMO OBJETIVO: Fazer uma avaliação qualitativa das cirurgias feitas em pacientes que sofreram luxações perilunares, sem fraturas associadas, que foram operados com o método de redução incruenta e fixação percutânea. O tempo de seguimento variou entre um e sete anos. MÉTODOS: Foram levantados prontuários de 628 pacientes, sob a denominação de lesões traumáticas no punho, operados pelo mesmo grupo de cirurgiões de mão, entre 2008 a 2014, com seguimento médio de 3,2 anos, devido a traumas agudos. Desses, 51 foram casos de fraturas-luxações perilunares, 38 eram luxações perilunares puras, sem fraturas associadas; dessas, apenas 32 tiveram fixação percutânea, sem reparo ligamentar, contemplaram assim os requisitos da pesquisa. Dos nove pacientes com luxações perilunares que foram tratados pelo método de redução fechada e fixação percutânea, com média de 38 anos (26 a 49), o lado dominante foi o esquerdo em 2/3 dos casos, o mecanismo de trauma predominante foi o direto. RESULTADOS: Este estudo convergiu com outros trabalhos na literatura, mostrou que os casos tratados precocemente apresentam bons resultados. CONCLUSÃO: Mantiveram suas atividades de vida diária e foram avaliados como excelentes ou bons pelo Clinical Scoring Chart 88% dos pacientes que foram tratados pelo método de redução fechada e fixação percutânea

Epidemiological analysis of adult carpal fractures at The Third Affiliated Hospital to Hebei Medical University from 2003 through 2012 / 中华创伤骨科杂志

Objective To investigate the epidemiological features and trends of adult carpal fractures at The Third Affiliated Hospital to Hebei Medical University from 2003 through 2012.Methods The clinical data were retrospectively analyzed of all the adult patients with carpal fracture who had been treated between January 2003 and December 2012 at our institute.The patients' age,gender and fracture type were documented.The data between 2003 and 2007 were classified as group A while the data between 2008 and 2012 as group B.The epidemiological characteristics during the 10 years concerning age,gender and fracture type were compared between the 2 groups.Results A total of 1,181 carpal fractures were collected,accounting for 5.99％ (1,181/19,712) of the hand fractures and 1.10％ (1,181/107,648) of the total fractures in the same period.They involved 967 males and 214 females,with a male/female ratio of 4.52∶ 1.The high-risk age group was from 21 to 30 years (33.28％);the high-risk type was scaphoid fracture (72.99％).In group A of 453 cases,the male/female ratio was 6.68∶1,the median age 29 years and the high-risk type scaphoid fracture (83.89％).In group B of 728 cases,the male/female ratio was 3.70∶ 1,the median age 34 years and the high-risk type also scaphoid fracture (66.21％).Group B had a significantly lower male/female ratio,a significantly lower proportion of scaphoid fractures and a significantly older median age than group A (P ＜ 0.05).Conclusions In the 10 years at our institute,adult carpal fractures accounted for 5.99％ of the hand fractures and 1.10％ of the total fractures in the same period.They mostly occurred in males and during the age from 21 to 30 years.Of all the carpal bones,the scaphoid was the most often fractured.The latter 5 years witnessed significantly increased median age,proportion of females and proportion of scaphoid fractures compared with the former 5 years.

Transtriquetral perihamate fracture-dislocation: case report / Fratura-luxação transtriquetral peri-hamato: relato de caso

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

RESUMO O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Multislice CT in diagnosis of associated carpal bone fractures in distal radial fractures / 中华全科医师杂志

Clinical data and radiological findings of 78 patients with distal radial fractures,who underwent plain X-ray film and muhislice CT (MSCT) examinations,were retrospectively analyzed.Twenty nine associated carpal bone factures were detected on X-ray film in 21 cases;while 47 associated carpal bone fractures were detected on MSCT in 29 cases (P ＜ 0.05).The missed diagnosis rate of X-ray was 38％.Results indicate that MSCT can significantly improve the detect rate,which should be recommended for diagnosis of associated carpal bone fractures in distal radial fractures.

Biomechanics of the Wrist

The wrist joint is a complicated structure composed of many bones and ligaments. Therefore, understanding the anatomy and the biomechanics of the wrist is important in order to administer proper treatment for patients. To easily understand the complicated structure, there were many trials to unite the complicated structure with a simple group such as the carpal row concept and the carpal column concept. Movement and load transfer along the wrist joint occurs with balanced action between carpal bones. To evaluate this static equilibrium, measuring tools such as carpal height ratio are used. When wrist flexion/extension occurs, each carpal row moves synchronously with action of the scaphoid. In contrast with flexion/extension, when wrist radial deviation/ulnar deviation occurs, the proximal carpal row moves in the sagittal plane, instead of the coronal plane. Recently, the dart throwing motion which occurred from the position of dorsiflexion with radial deviation to volar flexion with ulnar deviation is considered the main movement of the wrist joint.

Functional outcomes of proximal row carpectomy: 2-year follow-up

ABSTRACTOBJECTIVE: To evaluate functional outcomes of patients submit-ted to proximal row carpectomy for the treatment of wrist arthri-tisMETHODS: This is a retrospective study using wrist motion and grip strenght of patients diagnosed with Kienböck disease and scaphoid non-union surgically treated by this techniqueRESULTS: Eleven patients with 2-year follow-up were evaluated. Wrist motion (flexion, extension and ulnar deviation) and grip strength were significantly better from preoperative values. Ho-wever, no difference in radial deviation was observed in these patientsCONCLUSION: Proximal row carpectomy provides an alternative option for treatment of wrist arthritis, resulting in better active range of motion and grip strength in the long run. Level of Evidence IV, Case Series.

Luxación perilunar transescafoidea. Presentación de un caso / Perilunar Luxation. Case Report

Dentro del espectro de lesiones encontradas en las luxaciones perilunares dorsales o lesiones del arco mayor, la de mayor frecuencia se corresponde con la fractura-luxación trasescafo-perilunar dorsal. Mucho menos frecuente son las luxaciones que asocian fracturas del hueso grande y aquellas con fracturas desplazadas del piramidal. Por todo lo anterior, se presenta el caso de un paciente de 19 años de edad con antecedentes de salud anterior, que acudió a Cuerpo de Guardia del Hospital Gustavo Aldereguía Lima, de Cienfuegos, tras sufrir una caída sobre su mano izquierda. Se constató gran aumento de volumen en la muñeca izquierda, dolor intenso a pesar de la inmovilización e impotencia funcional absoluta. Se realizó reducción manual, bajo anestesia general, de la luxación perilunar del carpo. Mediante radiografías de control, anteroposterior y lateral de la muñeca, se constató la fractura del escafoides y sus características. Por la angulación y conminución marcada de la fractura se decidió tratamiento quirúrgico a cielo abierto, siguiendo técnica de Ruse, que fue aplazada hasta el décimo día de la lesión inicial, cuando la muñeca se encontraba menos inflamada y serían menos los riesgos de complicaciones. El paciente fue dado de alta de la consulta de ortopedia a los seis meses de operado mostrando resultados funcionales aceptables.

Within the specter of injuries found in dorsal perilunar luxation or injuries of the bigger arch, the one belonging to bigger frequency reciprocates with the fracture luxation trasescafo dorsal perilunar. Much less frequent are the luxations that associate the big bone’s fractures and those with displaced fractures of the pyramidal. Throughout the above, the case of a 19 year old patient is presented, that came to the emergency room of Gustavo Aldereguía Lima, Cienfuegos Hospital, after suffering a fall on his left hand with background of previous health. Great increase of volume in the left-handed wrist, acute pain in spite of immobilization and absolute functional impotence were verified. Manual reduction under general anesthesia of the perilunar luxation of the carpus was accomplished. By means of X-ray pictures of control, anteroposterior and lateral of the wrist, escafoides’s fracture and its characteristics were verified. For the marked angulation and conminution of the fracture surgical open-cast treatment was decided, using the technique of Ruse, that was postpone to the tenth day from the initial lesion, when the wrist was less inflamed and the risks of complications were less. The patient was discharged of the consultation of orthopedics to the six months of operated showing functional acceptable results.

Concomitant Carpal Injuries in Distal Radius Fractures: Retrospective Analysis by Plain Radiographs and Computed Tomography

PURPOSE: The purpose of this study is to evaluate the incidence and characteristics of concomitant carpal bone fractures and ligament injuries and to analyze risk factors for carpal injuries in patients with distal radius fractures. MATERIALS AND METHODS: A total of 362 patients with 379 distal radius fractures were reviewed retrospectively. Associated carpal bone fractures and ligament injuries were evaluated by plain radiographs and computed tomography at the time of initial trauma. Correlation between associated carpal injuries and various parameters was also analyzed. RESULTS: Of 379 distal radius fractures, 39 cases (10.3%) had one or more carpal bone fracture and 40 cases (10.6%) had carpal ligament injuries. Overall, carpal injuries occurred in 59 cases (15.6%) distal radius fractures. Associated carpal ligament injuries showed correlation with young age and associated carpal bone fractures showed correlation with AO type B distal radius fractures. Carpal injuries including fracture and ligament injury showed correlation with male, high energy trauma, or associated injuries beyond wrist. CONCLUSION: The incidence of concomitant carpal injuries in patients with distal radius fractures is relatively high. Concomitant carpal injuries were more common in young age, male, high energy trauma, AO type B distal radius fractures, or associated injuries beyond wrist.