Artrodesis de cuatro esquinas: análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica / Four-corner arthrodesis: comparative analysis of open surgery versus percutaneous technique with arthroscopic assistance

INTRODUCCIÓN: La artrodesis de cuatro esquinas es una técnica de salvataje para los pacientes con artrosis avanzada del carpo. Los objetivos quirúrgicos son disminuir el dolor y mantener cierto movimiento de la muñeca. En el último tiempo, se han descrito técnicas percutáneas con asistencia artroscópica que han logrado resultados favorables, a pesar de que la técnica abierta sigue siendo el gold estándar para realizar esa técnica quirúrgica. OBJETIVO: Comparar resultados funcionales y radiológicos en pacientes con muñecas con colapso avanzado escafolunar (scapholunate advanced collapse, SLAC) o colapso avanzado en la pseudoartrosis del escafoides (scaphoid nonunion advanced collapse, SNAC) operados con técnica quirúrgica abierta versus técnica percutánea con asistencia artroscópica. MATERIALES Y MÉTODOS: Estudio retrospectivo tipo caso-control, de fichas clínicas e imagenología de pacientes con artrosis avanzada del carpo operados con técnica percutánea y asistencia artroscópica y cirugía abierta. Se estudian variables demográficas, dolor mediante la Escala Visual Analógica (EVA), función en rangos de movilidad, tiempo de consolidación, y corrección del ángulo capitolunar. Se describe la técnica quirúrgica de la cirugía abierta y la cirugía percutánea con asistencia artroscópica. RESULTADOS: Se estudiaron 22 pacientes del sexo masculino con edad promedio de 32,5 años. Había 13 pacientes en el grupo de casos (técnica percutánea con asistencia artroscópica) y 9 pacientes en el grupo de controles (técnica abierta). El dolor en la EVA al momento del egreso hospitalario fue de 3 para los casos y de 5 para los controles (p » 0,008), y a los 30 días del postoperatorio, fue de 0 y 3 respectivamente (p » 0,00). Los rangos de extensión y flexión fueron de 52,6° y 38,7° para los casos y de 35,7° y 32,4° para los controles (p » 0,1119 y 0,0016, respectivamente). El ángulo capitolunar fue de 10° para los controles y de 5° para los casos (p » 0,0008). El tiempo de consolidación fue de 8,8 semanas para los casos y de 12,5 semanas para los controles (p » 0,039). DISCUSIÓN: Tanto la técnica percutánea con asistencia artroscópica cuanto la cirugía abierta para realizar una artrodesis de cuatro esquinas son técnicas reproducibles y efectivas en lograr consolidación, disminución del dolor, y mantenimiento de rangos de movimiento en la muñeca. CONCLUSIÓN: En el presente trabajo se demuestran mejores promedios de los parámetros evaluados con la técnica percutánea que con la cirugía abierta; sin embargo, es necesario realizar estudios prospectivos para realizar una recomendación con respecto a la técnica quirúrgica de elección.

INTRODUCTION: Four-corner arthrodesis is a salvage technique for patients with advanced carpal osteoarthritis. This procedure aims to reduce pain and preserve wrist motion. Even though percutaneous techniques with arthroscopic assistance reportedly have favorable outcomes and the advantages of minimal invasiveness, open surgery remains the gold standard for four-corner arthrodesis. OBJECTIVE: The present study aims to compare the functional and radiological outcomes of patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) submitted to open surgery versus percutaneous surgery with arthroscopic assistance. MATERIALS AND METHODS: Retrospective case-control study of clinical records and radiological images of patients with advanced carpal osteoarthritis submitted to percutaneous surgery with arthroscopic assistance versus open surgery. Demographic variables, pain score using the visual analog scale (VAS), function ranges of motion, time until consolidation, and correction of the capitolunate angle were analyzed. Both techniques are described. RESULTS: In total, 22 male patients with an average age of 32.5 years were studied, including 13 patients from the case group (percutaneous surgery with arthroscopic assistance) and 9 patients from the control group (open surgery). The VAS score for pain at discharge was of 3 for the cases and of 5 for the controls (p » 0.008); 30 days postoperatively, it was of 0 and 3 respectively (p » 0.00). The ranges of extension and flexion were of 52.6° and 38.7° for the case group, and of 35.7° and 32.4° for the control group (p » 0.119 and 0.0016 respectively). The capitolunate angle was of 10° for the controls and of 5° for the cases (p » 0.0008). The time until consolidation was of 8.8 weeks for the cases and of 12.5 weeks for the controls (p » 0.039). DISCUSSION: Both four-corner arthrodesis techniques are reproducible and effective in achieving consolidation, pain reduction and preservation of wrist motion. CONCLUSION: The present study demonstrates the superiority of the percutaneous technique with arthroscopic assistance over open surgery. Further prospective studies are required for an adequate recommendation.

Uncalcified Synovial Chondromatosis in the Pisotriquetral Joint

Synovial chondromatosis is a rare lesion in the wrist, but some cases in the distal radioulnar joint have been reported and previous case reports emphasize joint calcifications, shown on preoperative plain radiographs. We report an extremely uncommon case of synovial chondromatosis in the pisotriquetral joint, in which radiographs and magnetic resonance imaging did not demonstrate apparent calcified bodies. In our case, for the accurate diagnosis and treatment, surgical exploration of the joint and synovectomy with removal of loose bodies was performed.

[Comparison the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation in less than 7 years old children]

The radial head subluxation is a common cause in less than 7 years old children who refered to emergency center after pulling of their wrist by parents. Compare the method of wrist supination with elbow flexion as classical method with hyperpronation method in reduction of radial head subluxation [pulled elbow] in children less than 7 years old referig to poorsina hospital during 2004-2009. In this randomized clinical trial, children who had referred to Poursina orthopedic emergency center with clinical diagnosis of radial head subluxation were studied consequent. Patients were randomly treated as consequent male and female with one of two methods. The patients were checked in order to diagnosis extremity functions return every 5 minutes. If extremity function had not returned, the primary method was repeated after 15 minutes. Unsuccessful treatment led to treatment with another method 30 minutes after first try. That method repeated if replacing method was not successful after 15 minutes. If both methods were unsuccessful, elbow radiography to roll-out other injury was performed. After collecting data, analysis was performed using chi- square test and T- test with SPSS software version 16. Among 110 patients were included in this study with average age [4.05 +/- 1.51 years] 58 patients [3.91 +/- 1.41 years] with first method [SF] and 52 patients [4.21 +/- 1.62 years] with second method were treated. [P=0.31]%62.7 of patients were male and the remaining were female [%37.3]. In 47 patients [%90.4] of 52 patients who were treated by [HP] method. This was 46 patients [%79.3] from 58[P=0.11]. Five patients of [HP] group needed second attempt where as this number were 12 about [F] group. Treatment with [HP] method was successful in 100 percent patients, but successful rate was%87.9 for [SP] method. There was significant superiority of [HP] success in comparison to [SF] [P+0/006]. In reduction of radial head subluxation [HP] method was more successful upination method in reduction of radial head, it is more successful than supination, when supination was not successful than [SF] method

Comminuted Rolando's fractures: treatment with modified wrist external fixator and transmetacarpal pinning.

BACKGROUND: For comminuted Rolando's fracture, external fixation with early mobilization is the treatment of choice however, there is controversy in this treatment. Low-profile or mini external fixator can be used, but expense and availability of this kind of implant in Thailand has resulted in using various techniques of surgery. The purpose of this retrospective study was to present the authors' alternative technique with modified implants and the outcome in the management of comminuted Rolando's fracture. MATERIAL AND METHOD: The patients with comminuted Rolando's fracture were treated by using external fixation across the wrist (mostly by locally-made implants) between the radius and the first metacarpal and transmetacarpal K-wire fixation from the first to the second metacarpal. RESULTS: Between 1999 and 2005, six patients with a mean age of 25 years (range, 19-33 years) were studied The average follow-up period was four months. Satisfactory reductions were achieved in all fractures. The average operation time was 27.5 minutes. All closed fractures united within six weeks and had satisfactory results, which was normal range of motion of thumbs and wrists and with no complications. Only one opened fracture caused by a gun shot injury was healed in eight weeks and had a mild degree of reflex sympathetic dystrophy. CONCLUSION: Closed reduction and external fixation with modified wrist external fixator and transmetacarpal pinning is simple, safe, fast, and effective for the treatment of comminuted Rolando's fractures.

Resultados funcionais da artrodese do punho / Functional results of wrist arthrodesis

São analisados os resultados funcionais 51 artrodeses do punho em 49 pacientes, portadores de variadas patologias dessa região. Em todos os casos, a artrodese foi realizada com fixação interna rígida, usando placa e parafusos e o seguimento pós-operatório variou de 6 a 201 meses (média: 73 meses). Para a avaliação funcional foi empregado um método de subjetivo, baseado nas impressões dos próprios pacientes, e outro objetivo, através da análise das radiografias e de testes funcionais que simulam todo tipo de função do membro superior. A posição de fixação da artrodese foi de 14º de extensão e 8º de desvio ulnar, em média. Consolidação primária foi obtida em 50 (98 por cento) punhos, num período médio de oito semanas, sendo que, no punho restante ocorreu pseudartrose, consolidada após re-operação com enxertia óssea. Houve melhora da intensidade e mudança do padrão da dor pré-operatória e todos os pacientes com atividade leve retornaram ao trabalho.. Houve perda relativa da força de preensão manual (61 por cento do contralateral) e das pinças (cerca de 70 por cento do lado contralateral), porém os testes funcionais apresentaram resultados considerados satisfatórios e concordantes com a literatura. Conclui-se que a artrodese do punho é um método aplicável a diversas patologias que impliquem em dor e instabilidade da articulação, que produz resultados consistentemente repetitíveis, sem afetar significativamente a função global do membro superior, apesar da relativa perda da força, a qual se deveu mais a fatores pré-existentes do que a artrodese em si.

Abductor pollicis longus deviation grant operation: a new procedure on the thumb in ulnar cum low median palsy for correction of subluxation of carpometacarpal (CMC) joint.

For correction of instability of the carpometacarpal joint (CMC joint) of the thumb in combined paralysis of ulnar and median nerves in leprosy bone fusing procedures have been used, but they are not desirable and can often be avoided. A procedure analogous to the "Extensor pollicis brevis deviation graft operation" for the correction of instability of the metacarpophalangeal joint of the thumb is described here. The new procedure appears to be useful to correct and stabilize the subluxated carpometacarpal joint of the thumb actively during the use of the hand. When thumb web contracture has occurred and the passive range of movement needed for successful opponents replacement of thumb is not available, this new procedure helps to prepare such a severe deformed thumb for correction at earlier time.

Restauración de la pronosupinación, en diferentes patologías de la muñeca, por la técnica de Sauve-Kapandji / Restoration of the pronation-supination movement in different sequelae of the wrist joint by the Sauve-Kapandji technique

Se presenta una serie de 18 casos con 19 muñecas, con edad promedio de 40 años, que tenían artrosis de la unión radio-cubital distal, con inestabilidad en 8 casos, incongruencia en 11, artrosis no traumática en 8, artritis traumática en 8, y un caso de polio, de artritis reumatoide juvenil, de deformidad de Madelung y de gota. El tratamiento que se les realizó consistió en sinotosis radio-cubital distal y pseudoartrosis del cúbito, proximal a la sinostosis (Suave-Kapandji). Después de la cirugía la pronación aumentó de 23 a 64 grados en promedio y la supinación aumentó de 29 a 81 grados en promedio. El dolor postoperatorio persistió solamente en 5 casos, de mediana a baja intensidad y de aparición esporádica, ya fuera en la zona de la pseudoartrosis cubital o después de trabajo pesado

Artrodese do punho: revisäo de 54 casos / Arthrodesis of wrist: review of 54 cases

Foram analisados 54 artrodeses do punho. A indicaçäo foi em 23 punhos por lesöes pós-traumaticas, 10 por paralisias, 5 por contratura de Volkmann, 4 devido a artrites crônicas, 5 por deformidades congênitas e 6 por necrose vascular do semilunar. Em 3 pacientes a artrodese foi bilateral. Foram efetuados 45 artrodeses radio-cárpicas, 6 inter-cárpicas e uma radio-escafóide. Diferentes técnicas foram utilizadas e que näo influiram no resultado. Houveram 4 pseudartroses, 7,4%. Um caso de infecçäo 1,8% e 92,4% de fusäo de bons resultados. Os autores sugerem no final uma melhor observaçäo sobre as artrodeses parciais