Tumor de células gigantes en el extremo distal del radio / Giant Cell Tumor Of The Distal Radius

Introducción: El tumor de células gigantes de hueso es uno de los tumores menos frecuentes y su comportamiento local es agresivo. Objetivo: Presentar un caso afectado por un tumor de células gigantes tratado con resección en bloque y artrodesis de la articulación de la muñeca. Presentación del caso: Paciente masculino de 29 años de edad, con antecedentes relativos de salud, que presentaba desde hacía 5 meses aumento de volumen e impotencia funcional al realizar flexo extensión activa de la muñeca izquierda, con empeoramiento progresivo. Se diagnosticó tumor óseo de células gigantes con marcada actividad proliferativa estromal en el extremo distal del radio, se realizó resección en bloque y artrodesis del extremo distal del radio con márgenes oncológicos y transferencia del flexor radial corto al extensor común y del palmar menor al extensor y abductor del pulgar. Conclusiones: La resección en bloque y artrodesis es una de las opciones a tener en cuenta en la cirugía reconstructiva de la extremidad superior con un resultado satisfactorio(AU)

Introduction: Giant cell tumor of bone is one of the least frequent tumors and the local behavior is aggressive. Objective: To report a case with giant cell tumor treated with en bloc resection and arthrodesis of the wrist joint. Case report: A relative healthy 29-year-old male patient had had increased volume and functional impotence when performing active flexor extension of the left wrist for 5 months, with progressive worsening. A giant cell bone tumor with marked stromal proliferative activity was diagnosed in the distal end of the radius. En bloc resection and arthrodesis of the distal end of the radius were performed with oncological margins and the transfer of the flexor radialis brevis to the common extensor and the palmaris minor to the extensor and abductor pollicis. Conclusions: En bloc resection and arthrodesis is one of the options to consider in reconstructive surgery of the upper extremity with a satisfactory result(AU)

Aplicación de la técnica WALANT en las cirugías de mano / Use of WALANT Technique in Hand Surgeries

Introducción: En los últimos años la anestesia local sin torniquete y con el paciente despierto, técnica conocida por WALANT (por sus siglas en inglés), ha ganado mucha popularidad en las cirugías de la mano y la muñeca. Objetivo: Reportar nuestra experiencia con el uso de la técnica WALANT, a fin de prescindir del uso del torniquete en las cirugías de la mano. Métodos: En noviembre del 2020 fueron intervenidos 30 pacientes por diversas enfermedades ortopédicas, entre las que figuraron: dedos en resorte, síndrome del túnel carpiano, tenovaginitis estenosante del pulgar, gangliones del carpo y amputación del tercer radio por rigidez en extensión postraumática, entre otras. Para la evaluación de la técnica tuvimos en cuenta: tiempo quirúrgico, magnitud del sangrado, dolor durante la infiltración anestésica, la intervención, y en las primeras 24 horas del postoperatorio, la necesidad de refuerzo anestésico, uso de isquemia, complicaciones y nivel de satisfacción del paciente. Resultados: Los resultados obtenidos con esta técnica anestésica son semejantes a otras, con las ventajas que el sangrado es leve, no hay que utilizar isquemia, el tiempo quirúrgico es menor y el efecto anestésico duró entre 10 y 12 horas en todos los pacientes. En ninguno de los pacientes hubo necesidad de refuerzo anestésico. Conclusiones: Se demuestra la efectividad de la técnica WALANT en las cirugías de mano. Con ella se disminuye el gasto de materiales para el acto quirúrgico, así como de personal, es de fácil aplicación y disminuyen las sensaciones desagradables y los peligros del uso de isquemia en los pacientes(AU)

Introduction: Currently, the use of local anaesthetic with no tourniquet and wide awake patient (Wide Awake Local Anaesthetic No Tourniquet - WALANT) has gained popularity in surgeries of the hand and wrist. Objective: To report our experience in the use of WALANT technique in order to discard the use of tourniquet in hand surgeries. Method: In November 2020, thirty patients underwent surgery due to different orthopaedic conditions, among them trigger fingers, carpal tunnel syndrome, stenosing tenovaginitis of the thumb, carpal ganglion and amputation of the third radius due to post trauma stiffness, among others. In order to assess this technique, we considered surgical time, volume of bleeding, pain during anesthetic infiltration, intervention and the need for additional anesthetic during the first 24 hours after surgery; we considered also ischemia, complications and level patient´s satisfaction. Results: This technique had similar results to others; however, the bleeding is mild, there is no need for ischemia, the surgical time is lesser and the anesthetic effect lasted 10 to 12 hours in all patients. None of them required additional anesthetic. All subjects felt the initial infiltration but none complained of pain during the rest of the anesthetic injection or during the surgical act. There were no complications. Conclusions: The effectiveness of WALANT technique in hand surgeries is shown. The cost of materials for the surgical act is reduced with it, as well as the surgical staff, it is easy to use and unpleasant sensations and dangers of the use of ischemia in patients are reduced(AU)

Clinical observation of arthroscopic single channel treatment of carpal tunnel syndrome with self-made instruments / 中国骨伤

OBJECTIVE@#To investigate the efficacy of self-made arthroscopic single channel in the treatment of carpal tunnel syndrome.@*METHODS@#Sixty patients with primary carpal tunnel syndrome treated from January 2014 to December 2019 were divided into arthroscopic group and traditional open operation group. There were 30 cases in arthroscopic group, including 12 males and 18 females, aged (47.5±4.5) years and the course of disease was (6.6±4.2) months. There were 30 cases in the traditional operation group, including 10 males and 20 females, aged (48.5±3.5) years, and the course of disease was (5.6±4.4) months. Both groups were unilateral. According to the anatomy of wrist joint and the characteristics of transverse carpal ligament and arthroscopy, the instruments including cannula, inner heart and hook knife were designed. The patients in two groups were treated with decompression of transverse carpal ligament using arthroscopy combined with self-made instruments and traditional open sergery. The incision length, operation time, intraoperative bleeding, hospitalization cost, hospitalization time and recovery time of the two groups were observed and compared. Boston Carpal Tunnel Questionnaire (BCTQ) score was used to evaluate the clinical efficacy of arthroscopy combined with self made instruments in the treatment of carpal tunnel syndrome.@*RESULTS@#Compared with the traditional group, the arthroscopic group had significant advantages in incision length, operation time, intraoperative bleeding and hospital stay, but the total cost of hospitalization was increased. The Boston score was significantly higher in the arthroscopic group than that in the traditional group at 1 month after operation, but not at 3 and 6 months after operation.@*CONCLUSION@#Arthroscopy combined with self-made instruments in the treatment of carpal tunnel syndrome is more reliable, minimally invasive and simplified than open surgery, but the patients should be clearly diagnosed and appropriately selected before operation to achieve satisfactory clinical effect.

Evaluación de resultados calificada por el paciente en el análisis la diferencia de resultado funcional entre Fijación distal del segundo y tercer metacarpiano de placa de distracción dorsal en conminutivo distal fractura de radio / Patient-rated outcomes evaluation in analyzing the difference of functional outcome between second and third metacarpal distal fixation of dorsal distraction plating in comminutive distal radius fracture

Introduction: Comminuted distal radius fracture is one of the fractures that difficult to reduce. This study aimed to compare Patient-Rated Wrist Evaluation (PRWE) score between plating on second and third metacarpal groups. Methods: This study used a retrospective analytic research design with a sample of twenty seven cases of distal radius comminutive fractures that have been treated using dorsal distraction plating. Fifthteen cases with distal fixation in second metacarpal and twelve cases in third metacarpal. Data were then analyzed using the Mann-Whitney test. Results: The mean Pain scores in the second metacarpal and third metacarpal groups, respectively were 5.73 compared to 6.17. While the mean score of Function in the second metacarpal group and the third metacarpal group, respectively 12.67 compared to 13.83. The total PRWE score in the second metacarpal group was 18.40 compared to the third metacarpal group which was 20.0 (p>0.05). Conclusions: Patients with distal radius comminuted fracture treated using dorsal distraction plating with distal fixation in second metacarpal showed higher mean Pain, Function and total PRWE compared to third metacarpal, but there were no significant differences

Changes in Clinical Symptoms, Functions, and the Median Nerve Cross-Sectional Area at the Carpal Tunnel Inlet after Open Carpal Tunnel Release

BACKGROUND: The aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR). METHODS: Thirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times. RESULTS: BCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores. CONCLUSIONS: The study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities.

Retalho tenar adipofascial reverso para cobertura do nervo mediano hipertrofiado em macrodactilia / The reverse adipofascial thenar flap for coverage of the hypertrophied median nerve in macrodactyly

A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.

Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.

Comparison of Ultrasound-Guided Axillary Brachial Plexus Block Techniques: Perineural Injection versus Single or Double Perivascular Infiltration

PURPOSE: We compared three methods of ultrasound-guided axillary brachial plexus block, which were single, and double perivascular (PV) infiltration techniques, and a perineural (PN) injection technique. MATERIALS AND METHODS: 78 patients of American Society of Anesthesiologists physical status I-II undergoing surgery of the forearm, wrist, or hand were randomly allocated to three groups. 2% lidocaine with epinephrine 5 microg/mL was used. The PN group (n=26) received injections at the median, ulnar, and radial nerve with 8 mL for each nerve. The PV1 group (n=26) received a single injection of 24 mL at 12-o'clock position of the axillary artery. The PV2 group (n=26) received two injections of 12 mL each at 12-o'clock and 6-o'clock position. For all groups, musculocutaneous nerve was blocked separately. RESULTS: The PN group (391.2+/-171.6 sec) had the longest anesthetic procedure duration than PV1 (192.8+/-59.0 sec) and PV2 (211.4+/-58.6 sec). There were no differences in onset time. The average induction time was longer in PN group (673.4+/-149.6 sec) than PV1 (557.6+/-194.9 sec) and PV2 (561.5+/-129.8 sec). There were no differences in the success rate (89.7% vs. 86.2% vs. 89.7%). CONCLUSION: The PV injection technique consisting of a single injection in 12-o'clock position above the axillary artery in addition to a musculocutaneous nerve block is equally effective and less time consuming than the PN technique. Therefore, the PV technique is an alternative method that may be used in busy clinics or for difficult cases.

Deformidad de Madelung, a propósito de una serie de casos / Déformation de Madelung, à propos d'une série / Madelung's deformity, apropos of a case series

Introducción: la deformidad de Madelung es consecuencia de una alteración de crecimiento de la fisis distal del radio. Puede ocasionar dolor y pérdida de la función. Objetivos: revisar el estado actual de la enfermedad y conocer los resultados de una serie de pacientes, que han recibido tratamiento quirúrgico. Métodos: se trata de una serie de casos de pacientes (12 pacientes) recopilados entre los años 2005-2012, que fueron tratados en la consulta de cirugía de mano (entre 2005 y 2012). Los procedimientos quirúrgicos usados fueron osteotomía de radio con placa o con tutor, osteotomía de cúbito (de acortamiento y corrección angular) y resección distal del cúbito (Darrach). Se estudiaron variables de movilidad, radiología y satisfacción de la cirugía. Se analizaron los datos radiológicos de inclinación cubital y de inclinación del semilunar, además, de un análisis cualitativo de la corrección del cúbito. Resultados: en los 8 pacientes operados (11 muñecas: 9 corrección de la angulación del radio mediante osteotomías, y 2 con tutor), los resultados estéticos fueron buenos. En cuanto a la función, todos los parámetros de movilidad mejoraron. En las 7 muñecas en las que se realizó Darrach, mejoró el aspecto dorsal de la muñeca. Luego de poco tiempo no se observó traslación cubital del carpo. El aspecto radiológico mejoró notablemente: la inclinación cubital del radio cambió de 37º prequirúrgico a 28º posquirúrgico, y el ángulo de fosa del semilunar de 55º a 36º, respectivamente. Conclusiones: lo reducido de la serie y el poco tiempo de seguimiento constituye una limitación de este estudio, aunque se muestra que con la combinación oportuna de algunas técnicas de cirugía, se pueden lograr mejorías estéticas y funcionales en la deformidad de Madelung(AU)

Introduction: Madelung deformity is due to a growth disturbance of distal radius physis. It can cause pain and loss of function. Objectives: to review the current status of this disease and the results of a series of patients who received surgical treatment. Methods: this is a case series of patients (12 patients) collected from 2005 to 2012, which were treated in hand surgery consultation. Radio osteotomy plate or guardian ulna osteotomy (shortening and angular correction) and distal resection of the ulna (Darrach) were the surgical procedures used. Mobility variables, radiology, and surgery satisfaction were studied. Ulnar inclination and the lunate tilt radiological data were analyzed; also a qualitative analysis of the correction of the ulna was conducted. Results: in the 8 patients operated (11 wrists: 9 angle correction by osteotomy of the radius, and 2 with tutor), the aesthetic results were good. In terms of function, all mobility parameters improved. In the 7 cases of wrist where Darrach was performed, the dorsal aspect of the wrist improved. After a short time, no ulnar translation of the carpus was observed. The radiographic appearance markedly improved: the ulnar inclination changed from preoperative 37º to postoperative 28º and the lunate fossa angle changed from 55° to 36°, respectively. Conclusions: the smallness of the series and the short follow-up time is a limitation of this study, although it is shown that with the right combination of some surgical techniques aesthetic and functional improvements in Madelung deformity can be achieved(AU)

Introduction: la déformation de Madelung est due à une altération de la croissance distale du radius. Elle peut provoquer une douleur et une perte de la fonction. Objectifs: le but de cette étude est de réviser l'état actuel de la maladie et de connaître les résultats d'une série de patients ayant subi un traitement chirurgical. Méthodes: il s'agit d'une série de 12 patients traités entre 2005 et 2012 au Service de chirurgie de main. Les gestes chirurgicaux utilisés ont compris l'ostéotomie du radius par plaque ou par tuteur, l'ostéotomie de cubitus (raccourcissement et correction angulaire), et la résection distale du cubitus (Darrach). Des variables de mobilité, de radiologie et de satisfaction de la chirurgie ont été examinées. Les données radiologiques de la pente du cubitus et de la pente du semi-lunaire, ainsi qu'une analyse qualitative de la correction du cubitus, ont été évaluées. Résultats: on a réussi des résultats esthétiques très bons chez les 8 patients opérés (11 poignets: 9 corrections de l'angulation du radius par ostéotomie, et 2 corrections par tuteur. Tous les paramètres de mobilité par rapport au plan fonctionnel sont améliorés. L'image dorsale des 7 poignets opérés par la technique de Darrach est améliorée. Puis à près, la translation cubitale du carpe a disparu. L'image radiologique est remarquablement améliorée ; il y a eu un changement pré- et postopératoire de la pente cubitale du radius respectivement de 37° à 28°, et de l'angle de la fossette du semi-lunaire respectivement de 55° à 36°. Conclusions: quoique la faiblesse du nombre de la série et du temps du suivi ait limité cette étude, on a démontré que la combinaison de quelques techniques chirurgicales peut aboutir à l'amélioration esthétique et fonctionnelle de la déformation de Madelung(AU)

Indicações de artroplastia radiocubital distal: relato de três casos clínicos / Indications for distal radio-ulnar arthroplasty: report on three clinical cases

A artroplastia radiocubital distal é uma solução atrativa no tratamento de diferentes patologias da articulação radiocubital distal, pois permite restaurar a estabilidade, a transmissão de cargas e a função. As principais indicações são: o impingement radiocubital após ressecção parcial ou completa do cúbito distal e a artrite degenerativa, inflamatória ou pós-traumática da articulação radiocubital distal. Os autores apresentam três casos clínicos de patologia radiocubital distal: dois pacientes com sequelas pós-traumáticas e um caso de impingement radiocubital distal após operação de Sauvé-Kapandji. Os três casos foram tratados cirurgicamente com prótese metálica de substituição do cúbito distal tipo First Choice - Ascencion®. Os dois primeiros foram tratados com prótese tipo resurfacing e o último com prótese tipo modular. Em todos os pacientes obteve-se diminuição da dor e aumento da amplitude da RCD ao fim de um ano de seguimento pós-cirúrgico.

Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up.

Ganglionectomy without Repairing the Bursal Defect: Long-term Results in a Series of 124 Wrist Ganglia

BACKGROUND: Some surgeons consider the abscission of a part of the articular bursa around the point of the input of ganglion's nape (average 1-2 cm diameter) to be very important with excellent results. However, a literature search revealed disagreement as to whether it is essential to repair a bursa defect. This study examined the effectiveness of this method without repairing the articular defect. An attempt was made to identify the anatomical origin of wrist ganglia during the surgical procedure. METHODS: This study evaluated 124 wrist ganglia that had been treated surgically during 2004-2009 using this technique and without repairing the bursa defect (1-2 cm in diameter). The variables studied were age, gender, time from the occurrence till abscission of the ganglia, former surgical interventions, preoperative and postoperative pain, insertion of the ganglion's nape and complications. Sixty-six patients with a mean follow-up of 42 months and minimum 12 months were examined. RESULTS: At the time of the follow-up, 80.3% had no pain whereas 92.2% showed a remarkable improvement. Seven cases of recurrence (10.6%) were found 2 to 85 months after surgery, of which most appeared during the first year (71.4%). It is important to mention that the majority of the dorsal ganglia (42.8%) originated from the capitate-lunate joint. None of the patients presented with scapholunate or other instability. CONCLUSIONS: This surgical method is a simple and safe with excellent long-term results and a lower recurrence rate compared to other surgical approaches. Overall, repair of the articular bursa is unnecessary.

Tenossinovites De Quervain: uma nova proposta no tratamento cirúrgico / De Quervain’s tenosynovitis: a new proposal of surgical treatment

Introdução: A tenossinovite estenosante De Quervain caracteriza-se por ser a inflamação da bainha do abdutor longo e extensor curto do polegar, no primeiro compartimento dorsal do punho, acometendo mais frequentemente as mulheres na faixa etária entre 30 e 50 anos. Essa doença está associada principalmente a trauma crônico secundário e sobrecarga das atividades diárias das mãos e punho, podendo também ser causada por outros fatores, mas em muitos casos não há uma causa bem definida. Objetivo: O objetivo deste trabalho é apresentar nossa casuística de tenossinovite de De Quervain no Ambulatório de Cirurgia da Mão, os diferentes tratamentos e uma nova proposta cirúrgica utilizando um retalho fáscio-gorduroso de vizinhança. Resultados: Com a técnica proposta foram obtidos resultados satisfatórios, diminuindo as recidivas, com boa recuperação funcional e rápido retorno dos pacientes às atividades cotidianas.

Introduction: De Quervain’s stenosing tenosynovitis it is characterized by being the inflammation of the hem of the long and extending abductor short of the thumb, in the 1st number compartment of the fist, more frequently attacking the women in the age group between 30 and 50 years. That pathology is associated mainly to secondary chronic trauma and overload of the daily activities of the hands and fist, could also be caused by other factors, but in many cases no there is a very defined cause. Results: All the patients had a faster and satisfactory evolution with an amazing come back to their quotidian activities.

Síndrome do túnel carpal: resultados do tratamento cirúrgico com a técnica de mini-incisão / Carpal tunnel syndrome: results of surgical treatment with mini-incision technique

Introdução: A síndrome do túnel carpal é constituída por um conjunto de sinais e sintomas característicos como parestesia, formigamento, dor e perda da força nas mãos. Inicialmente os sintomas são brandos, progredindo ao longo do tempo. Objetivo: Apresentar os resultados do tratamento cirúrgico com mini-incisão, bem como discutir a relação entre os resultados e a técnica cirúrgica utilizada. Método: Esta pesquisa foi realizada na Faculdade de Medicina do ABC, onde foram avaliados 79 punhos de 71 pacientes, todos submetidos ao tratamento cirúrgico da síndrome do túnel carpal por ?mini-incisão?, entre janeiro de 1996 e maio de 2007. A média de idade entre os pacientes foi de 52,4 anos, sendo a idade mínima 27 e a máxima 80 anos. Sessenta e cinco pacientes eram do sexo feminino e seis do masculino. Quanto ao lado acometido, foram obtidos 36 punhos do lado direito e 27 do lado esquerdo, sendo 8 bilaterais. Resultados: Os resultados clínicos mostraram que 60 pacientes ficaram satisfeitos com os sintomas, com os resultados estéticos e funcionais e com a melhora da força muscular para apreensão. Dois pacientes apresentaram complicações cutâneas com infecção superficial e necessitaram de antibioticoterapia oral. Conclusões: Concluímos que o tratamento cirúrgico por ?mini-incisão? é uma técnica segura, com poucas complicações e resultados clínicos e estéticos satisfatórios para o tratamento da síndrome do túnel do carpo.

Introduction: The carpal tunnel syndrome is composed of signs and characteristic symptoms as parestesis, tingling, pain and hand power loose. Initially, the symptoms appear softly, progressing along the time. Objective: To present the results of surgical treatment using mini-incision, as well as to discuss the relationship between the results and the surgical technique used. Method: This study was accomplished at Faculdade de Medicina do ABC where 79 wrists of 71 patients were evaluated. All of them were submitted to the surgical treatment of the carpal tunnel syndrome using ?mini-open? technique between January 1996 and May 2007. The mean age of the patients was 52.4 years old, the minimum age was 27 years old and the maximum was 80 years old. Sixty-five patients were females and six were males. Thirty-six subjects had the right side affected and 27 had the left side, though 8 patients presented both sides affected. Results: The clinical results showed that 60 patients were satisfied with the symptomatic, aesthetic and functional results, as well as with the muscular power improvement for apprehension. Two patients presented cutaneous complications with superficial infection and were treated with oral antibiotic therapy. Conclusions: The surgical treatment using ?mini-incision? is a safe technique, with few complications and satisfactory clinical and aesthetic results for the carpal tunnel syndrome treatment.

Estudo comparativo do retorno da força da pinça após o tratamento da síndrome do túnel do carpo crônica associado a oponentoplastia / Comparative study of pinch power return after chronic carpal tunnel release associated with opponensplasty

A oposição do polegar é um importante e complexo movimento da mão, realizado por meio da musculatura tênar, que recebe inervação do nervo mediano, permitindo a realização do movimento de pinça, força e sensibilidade. O objetivo deste trabalho é comparar a força de pinça e grau de oponência do polegar, no pré e pós-operatório em 10 pacientes com síndrome do túnel do carpo crônica, hipotrofia da musculatura tênar e diminuição da força de pinça, que foram selecionados no nosso ambulatório de cirurgia da mão, e submetidos a cirurgia de oponentoplastia pela técnica de Camitz. Todos os pacientes evoluíram satisfatoriamente com rápido retorno as suas atividades cotidianas.

Thumb opponency is a complex and important hand’s movement, realized by the thenar muscle wich is innervated by the median nerve, providing it of sensibility, strength and the ability to do the pinch movement. The goal of this work is to compare the pinch strength and the degrees of opponency before and after the surgery in 10 patients with chronical carpal tunnel’s syndrome, hypotrophic thenar muscle and weakness of pinch’s movement, wich were selected in our hand’s surgery ambulatory center and submitted to an opponensplasty Thumb surgery using the Camitz technique. All the patients had a faster and satisfactory evolution with an amazing comeback to their quotidian activities.

Análise funcional da artrodese dos quatro cantos comparada com a carpectomia proximal / Functional analysis of four-corner arthrodesis compared to proximal carpectomy

Objetivo: O objetivo do estudo é analisar e comparativamente a artrodese dos quatro cantos e a carpectomia proximal do carpo realizadas em pacientes com punho acometido pelo colapso avançado escafo-semilunar. Métodos: O estudo avaliou 14 pacientes submetidos a carpectomia proximal e seis a artrodese dos quatro cantos, entre janeiro de 2000 e janeiro de 2004, para o tratamento de colapso avançado escafo-semilunar (SLAC). Os pacientes foram avaliados e comparados com relação à mobilidade, força, grau/gravidade da dor no pós-operatório. Resultados: Na casuística apresentada, os pacientes que foram submetidos à carpectomia proximal evidenciaram maior grau de flexo-extensão do punho operado e menor intensidade da dor pós-operatória. Os pacientes submetidos à artrodese dos quatro cantos tiveram maior perda da extensão e do desvio ulnar quando comparados com os que sofreram carpectomia proximal. Conclusões: A carpectomia proximal e a artrodese dos quatro cantos são boas opções de tratamento cirúrgico para pacientes com colapso avançado escafo-semilunar. São procedimentos, eficazes para o tratamento da dor e guardam mobilidade funcional do punho. Em nosso estudo, a perda da mobilidade foi maior nos pacientes submetidos à artrodese dos quatro cantos

Estudo anatômico da projeção cutânea do nervo mediano através de pontos topográficos / Anatomic study of the branching of the median nerve through topographic points

Atualmente, diversas vias de acesso têm sido empregadas na realização da cirurgia do canal do carpo, variando em e localização na palma da mão. Foram determinados pontos topográficos na palma da mão, visando estabelecer locais fixos e de simples identificação para, com isto, obter um local de fácil acesso ao retináculo dos flexores (RF), evitando comprometer qualquer estrutura no local do túnel do carpo. Os autores deste trabalho tomaram como base a técnica empregada por Serra et al (1997) e analizaram o estudo anatômico desta região para tornar a cirurgia do túnel do carpo ainda direitas e 10 esquerdas de cadáveres conservados em formadeído a 10% e operadas 10 mãos de paciente com Síndrome do túnel do carpo. Não se levou consideração as diferenças morfométricas de indivíduos étnicos. Em todas as peças estudadas identificou-se um ponto preciso , denominado X, sendo que a partir deste ponto localizou-se a margem distal do RF e a emergência da ramificação do nervo mediano (NM).

De Quervain's tendovaginitis stenosans in Jordanians

To study the De Quervain's Tendovaginitis Stenosans in Jordanians for triggering, septation and the presence or absence of tendons and their number. We operated on sixty-two wrists with the diagnosis of De Quervain's Tendovaginitis Stenosans, the mean age was 46 years old ranging from 28 to 77 years, amongst them were 44 females and 17 males. The right hand was the one affected in 37 and the left in 25, one of them had Bilateral. The dominant hand was affected in 35 cases while, the rest were not recorded. Occupation has some bearing as it has ranged from housewives, hairdressers, office secretaries, managerial jobs, heavy labor workers, handy men, farm hands and recent pregnancy and child birth. Twelve of the cases were of the triggering type; two of them had full septation, while three had partial septation. As for nodularity, five demonstrated a nodule in the Abductor Pollicis Longus [APL] or Extensor Pollicis Brevis [EPB]. Three had synovitis of Abductor Pollicis Longus and four had no nodularity or synovitis. Of the remaining fifty, 18 had full septation and a partial septation in 9, while the rest were in a single compartment. The number of tendons varied, fifty-five had a single [EPB] with no cases of APL absence. However, eighteen had one APL tendons, 33 had two, while six had 3 -4 or more slips of tendons. Fifty-eight patients of them attended for follow up. Forty-seven had full satisfaction; two reported scar hypertrophy, scar adherence in 3 and two cases of dysesthesis in the Superficial Branch of the radial Nerve [SBN]

Carpal tunnel release VIA mini-open wrist crease incision: procedure and results of four years clinical experience

To evaluate prospectively the safety and effectiveness of a mini-open technique for carpal tunnel release using a 1-1.5 centimeter wrist skin crease incision. Clinical experience with the technique consists of 98 patients and 124 hands over a period of four years, from October 1999 - October 2003. All cases were done as outpatient under local anesthesia Details of the technique, patient satisfaction and Outcomes are presented. The mean duration of the operation was 12 minutes. The technique was highly satisfactory cosmetically for all patients especially who previously experienced the open standard palmar incision in the other hand. Ninety-four percent of the patients were completely satisfied with the procedure regarding their symptoms. Five cases developed minor superficial wound infection No major nerve or vascular injury had occurred. Postoperative outcome measures and patient satisfactions [pain, return to normal activities and work, scar and pillar tenderness] were comparable with published series of endoscopic carpal tunnel release. This technique is simple, safe, cosmetically satisfactory and cost effective. It can be used by experienced hand surgeons especially in countries where endoscopic release is expensive and not widely available

Arthroscopic repair of isolated triangular fibrocartilage complex tears

A prospective study included 22 patients with a symptomatic triangular A. JL Jibrocartilage tear [Palmer's type IB or type 1C]. Pre-operative clinical diagnosis was confirmed by conventional MRI, MRI arthrogram and arthroscopically. All cases were arthroscopically repaired using the two needle technique. The mean follow-up period was 26 [range, 11 to 48] months. Pre-operatively, all patients complained of pain, restricted wrist and forearm motion and weakness of hand grip. According to the used El-Hadra wrist function scoring system, the mean pre-operative score was 9 [range, 4 to 12] points that improved after surgery to a mean of 20 [range, 16 to24] points, with thirteen wrists were graded excellent, eight good and one as fair. Pain was relieved completely in 15 wrists. Eighteen patients gradually returned to their original jobs and sports activities. The mean objective range of wrist movements increased to 91% of that of the normal side and the mean grip strength improved to 83% of the unaffected side. The results are encouraging and the procedure would seem to be an effective treatment for Palmer's types IB and 1C TFCC tears. It is also a less invasive option of management that may have mechanical advantages of stabilizing the ulnocarpal articulation and the distal radioulnar joint, while significantly improving the clinical symptoms

Surgical management of spastic flexion pronation deformity of forearm and wrist

This study included 26 forearms with spastic flexion pronation deformity of the wrist in 26 patients. The objectives of this study; were to throw out the light on the principles, prerequisites, and contraindications of surgical management for such deformity. Clinical assessment [pre and postoperative] included upper extremity function use score, active supination degrees, voluntary control level, steriogonosis, as well as [2 point] discrimination grades. The follow up period ranged from 6- 26 months and 2 cases were missed from this study. The results were satisfactory regarding the positive change in the average level of the upper extremity function use score [+ 2.7] from before to after surgeries. At the final follow up, the patients gained average 48 degrees of active supination in comparison to average of 3 degrees preoperatively. Also, there was significant change in the level of voluntary control at the end of the study. Finally, we concluded that surgical management of flexion pronation deformity of the forearm and wrist should be individualized and the surgical procedures should be tailored for every patient after thorough assessment of the mental status, sensibility deficit and the voluntary motor control