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1.
Rev. méd. Maule ; 37(1): 40-46, jun. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1397613

ABSTRACT

Calcific tendinitis is a pathology characterized by the deposits of periarticular hydroxyapatite. Its pathophysiology is not completely known. It is clinically characterized by important inflammatory changes with incapacitating pain. It most commonly affects the shoulder joint and it rarely affects the hand and wrist. Given the unusual nature of this localization, we present the clinical case of a woman who developed calcific tendinitis of the third metacarpophalangeal muscle. We present the clinical evolution of the case, the treatments carried out, and a review of the literature related to this unusual localization of calcific tendinitis.


Subject(s)
Humans , Female , Adult , Tendon Injuries/therapy , Wrist Injuries/therapy , Calcinosis/complications , Tendinopathy/complications , Acute Pain/etiology , Calcinosis/diagnosis , Magnetic Resonance Imaging , Radiography , Tendinopathy/diagnosis , Acute Pain/diagnosis
2.
Rev. bras. ortop ; 57(2): 348-350, Mar.-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1387998

ABSTRACT

Abstract Arthroscopy-assisted partial wrist-fusion techniques are becoming more popular nowadays. It became clearer that avoiding the violation of important ligament and tendinous structures - which is impossible when using the classic open techniques - enables a more biological approach, which is essential for faster healing and improvement in function. We describe the use of the triquetrum-hamate (TH) portal, which is seldomly applied in routine arthroscopic techniques for hand and wrist surgery, as an accessory portal to better perform anterior midcarpal debridement in four-corner fusion. This trick enables an almost complete anterior resection of the capitate and hamate chondral surfaces, increasing the subchondral osseous contact in the midcarpal joint after fixation, thus leading to higher consolidation rates.


Resumo As técnicas de fusão parcial do punho assistidas por artroscopia estão se tornando mais populares. Ficou claro que evitar a violação de importantes estruturas ligamentares e tendíneas, o que é imposssível com as técnicas abertas clássicas, permite uma abordagem mais biológica, essencial para a cicatrização mais rápida e melhora da função. Descrevemos o uso do portal piramidal-hamato (PH), raramente aplicado em técnicas artroscópicas de rotina para cirurgia de mão e punho, como portal acessório para melhor execução do desbridamento carpal medial anterior na fusão de quatro cantos. Esse truque possibilita a ressecção anterior quase completa das superfícies condrais do capitato e do hamato, o que aumenta o contato ósseo subcondral na articulação mesocárpica após a fixação e eleva as taxas de consolidação.


Subject(s)
Humans , Osteoarthritis/therapy , Arthroscopy/methods , Wrist Injuries/surgery , Wrist Joint/surgery
3.
Rev. bras. ortop ; 57(2): 341-344, Mar.-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1387987

ABSTRACT

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.


Subject(s)
Humans , Male , Adult , Wrist Injuries , Carpal Bones/injuries , Joint Dislocations , Pisiform Bone
4.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 8(1): e303, jun. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1248720

ABSTRACT

Introducción: Las fracturas metafisarias de radio distal son las fracturas más frecuentes en la edad pediátrica, siendo 30% del total de las mismas. Mantener la reducción de las fracturas desplazadas no siempre es posible: el re-desplazamiento es la principal complicación de estas lesiones. Clásicamente se realizó tratamiento con maniobra y yeso, aunque en los últimos años se asoció fijación con Kirschner wire (Kw) en búsqueda de disminuir el re-desplazamiento. El objetivo de nuestro trabajo es identificar factores de riesgo en búsqueda de realizar el mejor tratamiento siendo lo menos agresivo posible. Materiales y métodos: Se realizó una búsqueda sistematizada a través del buscador electrónico PubMed. La misma alcanzó un total de 4594 artículos, que de acuerdo con los criterios de inclusión y exclusión se seleccionaron 15 trabajos para realizar nuestra revisión bibliográfica. Resultados: Se destaca que la mayoría de los artículos encontrados son de nivel de evidencia III y IV. Nuestra búsqueda refleja un índice de re-desplazamiento entre 20-39% mediante yeso a las 2 semanas; asi como un índice de re-manipulación entre el 5-10 % del total de las fracturas desplazadas. La mayoría de los estudios analizados intentan identificar los factores de riesgo más importantes para el re-desplazamiento de las fracturas, de lo que se destacan el grado de desplazamiento inicial de la fractura y la reducción lograda de la misma. A su vez, otros artículos valoran los resultados del tratamiento mediante estabilización con yeso o fijación mediante Kirschner wire. Conclusión: el desplazamiento inicial de la fractura y la reducción lograda en block quirúrgico (BQ) son los factores de riesgo más importantes para el re-desplazamiento. Si bien la técnica de enyesado no es considerado una variable estadísticamente significativa, es considerada una variable importante en cuanto al pronóstico de la lesión, destacando al moldeado de 3 puntos como principal índice a considerar. Se considera aconsejable asociar un Kw en aquellas fracturas cabalgadas en las que no se logra una reducción anatómica en block quirúrgico.


Introduction: Distal radius metaphyseal fractures are the most frequent fractures in pediatric age, accounting for 30% of the total. Maintaining the reduction of displaced fractures is not always possible: re-displacement is the main complication of these injuries. Classically, treatment was performed with a maneuver and a cast, although in recent years fixation with Kirschner wire (Kw) has been associated in search of reducing re-displacement. The objective of our work is to identify risk factors in search of the best treatment while being the least aggressive possible. Materials and methods: A systematic search was carried out using the PubMed electronic search engine. It reached a total of 4594 articles, which according to the inclusion and exclusion criteria, 15 papers were selected for our bibliographic review. Results: It should be noted that most of the articles found are level of evidence III and IV. Our search reflects a re-displacement rate between 20-39% using a cast at 2 weeks; as well as a re-manipulation index between 5-10% of all displaced fractures. Most of the studies analyzed attempt to identify the most important risk factors for the re-displacement of fractures, of which the degree of initial displacement of the fracture and the reduction achieved are highlighted. In turn, other articles assess the results of treatment by stabilization with plaster or fixation with Kirschner wire. Conclusion: the initial displacement of the fracture and the reduction achieved in the surgical block (BQ) are the most important risk factors for re-displacement. Although the casting technique is not considered a statistically significant variable, it is considered an important variable in terms of the prognosis of the injury, highlighting the 3-point casting as the main index to be considered. It is considered advisable to associate a Kw in those mounted fractures in which an anatomical reduction in surgical block is not achieved.


Introdução: As fraturas metafisárias do rádio distal são as mais frequentes na idade pediátrica, correspondendo a 30% do total. Manter a redução das fraturas desviadas nem sempre é possível: o deslocamento é a principal complicação dessas lesões. Classicamente, o tratamento era realizado com manobra e gesso, embora nos últimos anos a fixação com fio de Kirschner (Kw) tenha sido associada na busca pela redução do deslocamento. O objetivo do nosso trabalho é identificar os fatores de risco em busca do melhor tratamento sendo o menos agressivo possível. Materiais e métodos: uma busca sistemática foi realizada usando o mecanismo de busca eletrônico PubMed. Chegou-se a um total de 4.594 artigos, que de acordo com os critérios de inclusão e exclusão, foram selecionados 15 artigos para nossa revisão bibliográfica. Resultados: Ressalta-se que a maioria dos artigos encontrados são de nível de evidência III e IV. Nossa pesquisa reflete uma taxa de re-deslocamento entre 20-39% usando um gesso em 2 semanas; bem como um índice de remanipulação entre 5-10% de todas as fraturas deslocadas. A maioria dos estudos analisados ​​busca identificar os fatores de risco mais importantes para o deslocamento das fraturas, que incluem o grau de deslocamento inicial da fratura e a redução alcançada. Por sua vez, outros artigos avaliam os resultados do tratamento com estabilização gessada ou fixação com fio de Kirschner. Conclusão: o deslocamento inicial da fratura e a redução alcançada no bloqueio cirúrgico (QB) são os fatores de risco mais importantes para o deslocamento. Embora a técnica de gesso não seja considerada uma variável estatisticamente significativa, é considerada uma variável importante em termos de prognóstico da lesão, destacando-se o gesso em 3 pontos como o principal índice a ser considerado. Considera-se aconselhável associar um Kw nas fraturas montadas em que não se consegue redução anatômica no bloqueio cirúrgico.


Subject(s)
Humans , Radius Fractures/surgery , Radius Fractures/complications , Wrist Injuries/surgery , Wrist Injuries/complications , Evaluation of Results of Therapeutic Interventions , Orthopedic Procedures/methods , Skeleton/growth & development , Risk Factors
5.
Rev. bras. ortop ; 56(3): 340-345, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288673

ABSTRACT

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.


Subject(s)
Humans , Wrist Injuries , Carpal Bones/injuries , Joint Dislocations , Fractures, Bone , Orthopedic Surgeons
6.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 629-638, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353969

ABSTRACT

Introducción: Las luxofracturas radiocarpianas consisten en la pérdida total de contacto entre las superficies articulares de la primera fila del carpo y del radio. Se producen por traumatismos de alta energía. El objetivo de este estudio fue evaluar retrospectivamente una serie de casos para comparar la incidencia de estas lesiones, el manejo terapéutico y los resultados funcionales con la bibliografía publicada por centros de referencia en esta enfermedad. Materiales y métodos: Entre febrero de 2018 y junio de 2020, se evaluó, en forma retrospectiva, a pacientes con luxofractura radiocarpiana, clasificada en tipos I y II según Dumontier. Criterios de inclusión: hombres y mujeres >18 años con luxofractura radiocarpiana cerrada o abierta y un seguimiento mínimo de 3 meses. Se llevó a cabo un seguimiento clínico/por imágenes mediante radiografías, el cuestionario DASH, la escala de muñeca modificada de la Clínica Mayo, la escala analógica visual para dolor y el PSQ-18. Resultados: Se evaluó a 8 pacientes con 9 lesiones, y un seguimiento promedio de 8 meses. Las luxaciones eran 4 tipo I y 5 tipo II. Todos fueron operados. Según valores finales, hubo 2 resultados excelentes, 6 buenos/aceptables y uno pobre. Conclusión: El mejor método para el tratamiento definitivo es quirúrgico. La correcta clasificación y el estudio de la enfermedad tienen un rol fundamental en la toma de decisiones terapéuticas. Nivel de Evidencia: IV


Introduction: Radiocarpal fracture-dislocations consist of the total loss of contact between the articular surfaces of the first row of the carpus and the radius. They are caused by high-energy trauma. The purpose of the work is to retrospectively evaluate a series of cases to compare the incidence of these lesions, their therapeutic management and functional outcomes with the literature published by reference centers in this pathology. Materials and methods: Between February 2018 and June 2020 we retrospectively evaluated patients with radiocarpal fracture-dislocations, which were classified into groups I and II according to Dumontier. Inclusion criteria: males and females over 18 years of age with closed or open radiocarpal fracture-dislocations with a minimum follow-up of 3 months. A clinical/imaging follow-up was carried out using radiographs, the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand), Modified Mayo Wrist Score, visual analog scale (VAS) and Patient Satisfaction Questionnaire Short Form (PSQ-18). Results: Eight patients with nine lesions with an average follow-up of 8 months were evaluated. Lesions were grouped into type I (4) and type II (5). All were surgically operated. According to the final values, outcomes were excellent in two cases, good/acceptable in six, and poor in one. Conclusion: We believe that the best method for definitive treatment is surgical. The correct classification and study of the pathology will play a fundamental role in making therapeutic decisions. Level of Evidence: IV


Subject(s)
Adult , Wrist Injuries/surgery , Wrist Injuries/classification , Wrist Joint/surgery , Retrospective Studies , Treatment Outcome , Joint Dislocations , Fractures, Bone
7.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 666-680, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353974

ABSTRACT

El objetivo de este artículo es actualizar los conocimientos sobre la impactación cubitocarpiana y su tratamiento. Estudios clásicos sobre la biomecánica del borde cubital de la muñeca han demostrado que los cambios milimétricos en la relación de longitud entre el cúbito y el radio alteran significativamente la transferencia de cargas entre los huesos del carpo, el radio y el cúbito. Así, un aumento relativo en la longitud del cúbito generará una carga excesiva sobre la articulación cubitocarpiana que producirá un espectro de cambios degenerativos progresivos en el domo cubital, el semilunar, el piramidal y el complejo del fibrocartílago triangular que finalizarán con artrosis cubitocarpiana y radiocubital distal. La impactación cubitocarpiana, en sus diversos estadios degenerativos, se puede tratar mediante osteotomías que buscan descomprimir la carga cubitocarpiana. Las osteotomías pueden ser extrarticulares o intrarticulares. Entre las extrarticulares, están las diafisarias, las metafisarias sin exposición articular (subcapitales) y las metafisarias distales con exposición articular y, entre las intrarticulares, la cirugía de resección en oblea (wafer), que reseca cartílago y hueso subcondral del domo cubital, y puede ser un procedimiento abierto o artroscópico. Si hay artrosis radiocubital distal, solo se podrá tratar con cirugías de rescate, como Darrach, Sauvé-Kapandji, Bowers, o una prótesis radiocubital distal. Estas técnicas de osteotomía se han analizado detalladamente para lograr definir sus ventajas y desventajas. Finalmente se propone una forma de tipificar la impactación cubitocarpiana, cuyo objetivo es orientar al lector hacia el mejor tratamiento posible, avalado por la bibliografía actual. Nivel de Evidencia: V


The purpose of this article is to provide updated knowledge about ulnocarpal impaction syndrome (UCIS) and its treatment. Classic studies on biomechanics of the ulnar side of the wrist have shown that millimetrical changes in the relative lengths of the ulna and the radius significantly alter the load transmission between the carpal bones, the radius and the ulna. Thus, an increase in the relative length of the ulna will generate an excessive load on the ulnocarpal joint, which will produce a spectrum of progressive degenerative changes in the ulnar dome, lunate, triquetrum, and the triangular fibrocartilage complex (TFCC), that will lead to ulnocarpal and distal radioulnar joint (DRUJ) osteoarthritis. In its various degenerative stages, UCIS can be treated with osteotomies that seek to decompress the ulnocarpal load. These can be extra-articular or intra-articular. Within the extra-articular osteotomies, we find the diaphyseal, metaphyseal without joint exposure (subcapital), and the distal metaphyseal with joint exposure. Within the intra-articular ones, we find the wafer procedure, which resects the cartilage and subchondral bone of the ulnar dome, and can be performed either openly or arthroscopically. If there is associated DRUJ osteoarthritis, it can only be treated with salvage surgeries such as the Darrach, Sauvé-Kapandji, and Bowers procedures, or a DRUJ arthroplasty. These osteotomy techniques will be analyzed in detail in order to define their advantages and disadvantages. Finally, we propose a way to typify the UCIS to guide the reader towards the best possible treatment supported by current literature. Level of Evidence: V


Subject(s)
Osteotomy , Ulna/surgery , Ulna/injuries , Wrist Injuries/surgery , Biomechanical Phenomena , Triangular Fibrocartilage
8.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(5) (Nro Esp - AACM Asociación Argentina de Cirugía de la Mano): 581-594, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353964

ABSTRACT

Objetivo: Evaluar, en forma retrospectiva, la función y los resultados objetivos de los pacientes con lesión foveal del complejo del fibrocartílago triangular mediante anclaje óseo sin nudo artroscópico. Materiales y métodos: Se evaluó, en forma retrospectiva, a 12 pacientes con lesión foveal del complejo del fibrocartílago triangular Atzei 2/3 y un seguimiento promedio de 18 meses. Todas las lesiones se repararon con artroscopia mediante la guía de fibrocartílago y anclaje óseo sin nudo. Se evaluaron los rangos de movilidad y la fuerza de agarre con la escala de muñeca de la Clínica Mayo y el cuestionario DASH. Resultados: Se obtuvieron mejoras en la prueba del dolor y la fuerza; el rango de movilidad promedio fue de 70° de extensión, 85° de flexión, 20° de desviación radial y 30° de desviación cubital. Los resultados según la escala de muñeca de la Clínica Mayo fueron excelentes en el 83% y buenos en el 17%, no hubo resultados malos. El puntaje promedio del cuestionario DASH fue 56 en el preoperatorio y 8 en el posoperatorio. El promedio de la fuerza comparativa contralateral fue del 70%. Conclusiones: La reparación artroscópica de las lesiones Atzei 2/3 mediante anclaje óseo sin nudo logra buenos resultados, mejora los rangos de movilidad, recupera la estabilidad en todos los casos y la fuerza total o parcial. Nivel de Evidencia: IV


Objective: To retrospectively evaluate the functional and objective outcomes in patients with foveal lesions of the triangular fibrocartilage complex treated with arthroscopic knotless bone anchors. Materials and methods: We retrospectively evaluated 12 patients with Atzei 2/3 foveal lesions of the triangular fibrocartilage complex with an average follow-up of 18 months. All the lesions were repaired arthroscopically using a fibrocartilage guide and knotless bone anchors. The ranges of motion and grip strength were assessed with the Mayo Clinic wrist scale and the DASH questionnaire. Results: Improvements were obtained in the pain and strength test; the average range of motion was 70° in extension, 85° in flexion, 20° in radial deviation, and 30° in ulnar deviation. The outcomes according to the Mayo Clinic wrist scale were excellent in 83% of the cases and good in 17%; there were no poor outcomes. The average DASH score was 56 preoperatively and 8 postoperatively. The average contralateral comparative strength was 70%. Conclusion: The arthroscopic repair of Atzei 2/3 lesions with knotless bone anchors achieves good outcomes, improves ranges of motion, and restores stability and total or partial strength in all cases. Level of Evidence: IV


Subject(s)
Adult , Arthroscopy/methods , Wrist Injuries/surgery , Treatment Outcome , Triangular Fibrocartilage/surgery , Triangular Fibrocartilage/injuries
9.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(3): 197-203, ago. 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1340620

ABSTRACT

Introducción: El tratamiento de las fracturas de muñeca con placas volares bloqueadas puede ser insuficiente para las fracturas con fragmentos volares marginales distales a la línea de inserción distal del pronador cuadrado, sitio de inserción de importantes ligamentos. Objetivo: Evaluar la reproducibilidad de la técnica y los resultados del tratamiento de fracturas marginales volares de radio distal con clavijas, capturando el fragmento volar y dejándolas debajo de la placa volar bloqueada de radio distal. Materiales y Métodos: La técnica quirúrgica utiliza una o varias clavijas para fijar el fragmento volar semilunar del radio distal, bloqueándolas debajo de la placa. Inicialmente efectuamos una simulación cadavérica. Luego, realizamos un estudio retrospectivo que incluyó a 7 pacientes con fracturas de radio distal intrarticular con un fragmento marginal volar distal a la línea de la orilla, tratados entre septiembre de 2014 y febrero de 2015. El promedio de edad era de 53 años, y el del seguimiento, de 16 meses. Se obtuvieron radiografías en sucesivos controles. Al alta se evaluaron el rango de movilidad, la fuerza de prensión y dos puntajes funcionales. Resultados: Todas las fracturas consolidaron satisfactoriamente manteniendo la reducción del fragmento marginal volar. No hubo casos con inestabilidad radiocubital inferior como secuela. Conclusión: La fijación adicional del fragmento marginal volar lunar del radio con clavijas dobladas por debajo de la placa ofrece una alternativa de estabilización sencilla, económica y adecuada para suplir la fijación de un fragmento que la placa sola no estabilizaría adecuadamente. Nivel de Evidencia: IV


Introduction: Wrist fracture management with volar locking plates may be insufficient in fractures with volar marginal fragments distal to the line insertion of the pronator quadratus, the insertion site of important ligaments. Objective: To evaluate the reproducibility and results for the treatment of volar marginal fragment in distal radius fractures with a technique of pin fixation, capturing the fragment and securing them under the distal radius volar locking plate. Materials and Methods: The surgical technique uses one or more pins for the fixation of the volar lunate facet fragment in the distal radius, securing the pins under the locking plate. We initially performed a cadaveric simulation. Then we conducted a retrospective study on 7 patients with distal radius intra-articular fractures and volar marginal fragments distal to the watershed line, treated between September 2014 and February 2015. The average age was 53 years, and the average follow-up was 16 months. Radiographs were obtained in successive controls. Range of motion, grip strength, and 2 functional scores were assessed at discharge. Results: All fractures healed successfully maintaining reduction of the volar marginal fragment. There were no cases of postoperative distal radio ulnar joint instability. Conclusion: Additional fixation of volar marginal fragment in distal radius fractures with bent pins under the plate provides an easy, affordable and adequate alternative to supply the adequate fragment stabilization that plate-alone techniques do not achieve. Level of Evidence: IV


Subject(s)
Adult , Middle Aged , Radius Fractures/surgery , Wrist Injuries , Bone Plates , Fracture Fixation, Internal/methods
10.
Rev. cuba. ortop. traumatol ; 34(1): e192, ene.-jun. 2020. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1139111

ABSTRACT

RESUMEN Las fracturas-luxaciones carpianas son lesiones poco frecuentes que ocurren tras traumatismos de alta energía y que, inicialmente, muchas veces pasan desapercibidas. Se presenta un paciente de 32 años de edad, masculino, que había sido atendido seis semanas antes en la consulta de trauma tras caer de una altura aproximada de 6 metros. Se diagnosticó luxación aislada del semilunar y se le realizó carpectomía parcial. La evolución fue satisfactoria, el paciente se incorporó a su vida social activa a las 16 semanas del acto operatorio. Tras un año de evolución presentó dolor leve y ocasional(AU)


ABSTRACT Carpal fracture-dislocations are rare injuries that occur after high-energy trauma and that, initially, often go unnoticed. A case of a 32-year-old male patient is reported, he had been treated six weeks earlier in the trauma clinic after falling from a six meter height approximately. An isolated lunate dislocation was diagnosed and partial carpectomy was performed. The evolution was satisfactory, the patient joined his active social life 16 weeks after the operation. After a year of evolution, he showed mild and occasional pain(AU)


Subject(s)
Humans , Male , Adult , Lunate Bone/injuries , Wrist Injuries/surgery , Fracture Dislocation/surgery
11.
Rev. bras. ortop ; 55(1): 1-7, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092680

ABSTRACT

Abstract Arthroscopy is a surgical technique whose indication for wrist injuries has grown in recent years. Athletes are subject to traumatic injury to the wrist due to training overload or the intensity of the activity during competition. The need of a quick return to sports practice makes arthroscopy a very useful minimally invasive technique in these situations. The authors present indications of sports-related injuries to the wrist that can be treated by arthroscopy. A literature review is also presented.


Resumo A artroscopia é uma técnica cirúrgica que tem sido cada vez mais usada para a abordagem de lesões no punho. Atletas estão sujeitos a lesões traumáticas no punho devido à sobrecarga de treinamento ou à intensidade da atividade em competição. A necessidade de retornar o mais breve possível à pratica esportiva faz da artroscopia uma técnica minimamente invasiva muito útil nessas situações. Os autores apresentam as principais indicações de tratamento de lesões esportivas por artroscopia. Foi feita uma revisão da literatura.


Subject(s)
Humans , Arthroscopy/methods , Athletic Injuries , Sports , Wounds and Injuries , Wrist Injuries/diagnosis , Athletes , Return to Sport , Hand Injuries/diagnosis
12.
Article in English | WPRIM | ID: wpr-828986

ABSTRACT

Objective@#The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.@*Methods@#We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits.@*Results@#The injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up.@*Conclusion@#Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.


Subject(s)
Adult , Beijing , Burns, Electric , General Surgery , Humans , Male , Retrospective Studies , Surgical Flaps , Thigh , Wound Healing , Wrist Injuries , General Surgery , Young Adult
13.
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1124134

ABSTRACT

La asociación entre fractura de radio distal y fractura de escafoides es una asociación infrecuente, en la presentación inicial, pasa inadvertida muchas veces la fractura a nivel de escafoides. El diagnóstico precoz nos permite un correcto tratamiento evitando posibles complicaciones en la evolución. Se presenta el caso de un adolescente de 14 años con dicha asociación lesional. Se le realizó reducción cerrada y fijación percutánea con alambres de Kirschner a nivel del radio distal y se trató la fractura de escafoides, de forma ortopédica, con yeso antebraquipalmar con inclusión del primer dedo. Se obtuvo la consolidación de ambos focos con excelentes resultados clínicos.


The association between distal radius fracture and scaphoid fracture is a rare association, in many cases the scaphoid fracture can be overlooked at the initial presentation. The early diagnosis allows a correct treatment avoiding possible complications in the follow-up. The case of a 14-year-old teenager with this association is presented. Closed reduction and percutaneous fixation was performed with Kirschner Wires at distal radius fracture, the scaphoid fracture was treated orthopedically with short-arm thumb spica cast. Consolidation of both fractures was obtained with excellent clinical results.


A associação entre fratura do rádio distal e fratura do escafoide é uma associação pouco freqüente; na apresentação inicial, a fratura do escafóide geralmente passa despercebida. O diagnóstico precoce nos permite um tratamento correto, evitando possíveis complicações na evolução. É apresentado o caso de um adolescente de 14 anos com essa associação lesional. Ele foi submetido a redução fechada e fixação percutânea com fios de Kirschner no raio distal, e a fratura do escafóide foi tratada ortopedicamente com um molde de antebraço incluindo o primeiro dedo. A consolidação de ambos os focos foi obtida com excelentes resultados clínicos.


Subject(s)
Humans , Male , Adolescent , Radius Fractures/therapy , Radius Fractures/diagnostic imaging , Wrist Injuries/diagnostic imaging , Scaphoid Bone/injuries , Splints , Wrist Injuries/therapy , Bone Wires , Closed Fracture Reduction , Fracture Fixation, Internal/methods
14.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 353-360, dic. 2019. []
Article in Spanish | LILACS, BINACIS | ID: biblio-1057060

ABSTRACT

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volar bloqueada. Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II). Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH y el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024). Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. Nivel de Evidencia: III


Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. Level of Evidence: III


Subject(s)
Adult , Radius Fractures/surgery , Radius Fractures/therapy , Ulna Fractures/surgery , Ulna Fractures/therapy , Wrist Injuries , Follow-Up Studies , Treatment Outcome
15.
Belo Horizonte; s.n; 2019. 63 p. ilus., tab..
Thesis in Portuguese | LILACS, ColecionaSUS | ID: biblio-1371781

ABSTRACT

Desordens da articulação radioulnar distal (ARUD) de diferentes etiologias são relativamente comuns e podem afetar gravemente a função do punho e antebraço. As lesões agudas, se não identificadas e tratadas, podem evoluir com dor e instabilidade crônica e quadros degenerativos em estágios mais avançados. Devido a características ósseas locais, a estabilidade é dada principalmente pelas partes moles, sendo o complexo de fibrocartilagem triangular (CFCT) a principal estrutura. A restauração da estabilidade da ARUD é objetivo do tratamento e as reconstruções constituem o grupo principal quando se trata de lesões crônicas sem artrose. O objetivo deste trabalho é descrever uma técnica de tenoplastia com uma tira do tendão do músculo flexor ulnar do carpo (FUC), para reconstrução anatômica da ARUD, e demonstrar a estabilidade dorsal e volar e a manutenção da pronossupinação após a reconstrução. Foram selecionados 10 cadáveres frescos sem sinais de lesões ou cirurgias prévias nos membros superiores e a técnica cirúrgica foi aplicada em ambos os punhos, totalizando 20 reproduções realizadas pelo mesmo médico-cirurgião da mão. Imagens foram registradas em cada passo da técnica em cinco cadáveres e reproduções computadorizadas foram criadas a seguir. Após a utilização de um cadáver piloto, outros quatro cadáveres foram submetidos a testes para verificação da melhora das translações dorsal e volar sobre carga mensurada e da manutenção da amplitude de movimentos após o procedimento. A técnica do presente estudo apresenta diversas vantagens em relação aos procedimentos já descritos na literatura, pois constitui uma reconstrução do CFCT, que tenta reproduzir a anatomia mais próxima do normal. Isso permite ganho de estabilidade em plano sagital e coronal, sem a limitação do movimento de pronossupinação. Outras vantagens do trabalho incluem a realização de apenas dois túneis ósseos, permanência de uma tensão constante do enxerto, sem afrouxamento com o tempo, por se tratar de uma tenoplastia dinâmica, manutenção da função primária do FUC e menos necessidade de dissecção. A técnica descrita reconstrói o complexo ligamentar da articulação radioulnar distal com a utilização de menor número de túneis ósseos e a correção da incongruência nos planos frontal e sagital. Mostrou também a correção, em cadáveres, das translações dorsal e volar e amplitudes de movimentos preservadas após a sua realização, se


Disorders of the distal radioulnar joint (DRUJ) of different etiologies are relatively common and can severely affect wrist and forearm function. Acute lesions, if unidentified and treated, may evolve with chronic pain and instability, or degenerative disease in more advanced stages. Due to local bone characteristics, stability is mainly given by the soft tissues, among which the triangular fibrocartilage complex (TFCC) is the main structure. Restoration of DRUJ stability is the goal of treatment and the reconstructions constitute the main group when treating chronic non-arthritic lesions. The objective of this paper is to describe a new technique of tenoplasty using a strip of flexor carpi ulnaris (FCU) tendon, for anatomical reconstruction of the DRUJ and to show dorsal and volar stability and maintenance of prono-supination after reconstruction. Ten fresh cadavers without signs of lesions or previous surgeries in the upper limbs were selected and the surgical technique was applied to both wrists, totaling 20 reproductions performed by the same hand surgeon. Photographs and finite models were made in five cadavers detailing the most important points of each steps of technique. After one pilot cadaver, other four cadavers tests were made to show improvement of dorsal and volar translations and maintenance of range of motion after the procedure. The technique of this study presents several advantages when compared to the procedures already described in the literature, because it reconstructs the TFCC and brings anatomy closer to the normal. This allows gain of stability in the sagittal and coronal plane, without compromising range of motion. Other advantages of this study include performing only two bone tunnels, with reduced risk of iatrogenic fracture; maintaining a constant tension of the graft, without loosening over time, considering that it is a dynamic tenoplasty; conservation of the primary function of the FCU, without the need of an aggressive dissection. The technique reconstructs the DRUJ complex, with technical advantages over other described procedures, being a good alternative for the treatment of chronic instabilities of DRUJ without arthritis.


Subject(s)
Wrist Joint , Triangular Fibrocartilage , Wrist Injuries , Orthopedic Procedures , Joint Instability , Joints
16.
Artrosc. (B. Aires) ; 26(2): 45-51, 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1016451

ABSTRACT

Introducción: Nuestro propósito de realizar este trabajo retrospectivo fue determinar la función y los resultados objetivos de los pacientes con lesiones escafolunar mediante la Capsulodesis dorsal artroscópica tipo Mathoulin modificada. Material y Métodos: Evaluamos 12 pacientes con lesión del ligamento escafolunar, mediante la clasificación de Geissler ,EWAS y García Elías. Se evaluaron 9 hombres y 3 mujeres. El 100 % en edad laboral. El tiempo de seguimiento post operatorio fue de 7,8 meses (4-12 meses). Tres de los pacientes fueron tratados de forma aguda (hasta los 2 meses de dolor o inestabilidad) y 9 pacientes de forma crónica (más de 3 meses de dolor o inestabilidad). Todos los pacientes tenían dolor escafolunar dorsal y test de Watson positivo. Todas las lesiones fueron reparadas con la técnica artroscópica de Capsulodesis Dorsal de Mathoulin modificada. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, score Mayo de Muñeca y el DASH Score. Resultados: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue 71° para la extensión, 65° de flexión, 25° para la desviación radial y 25° de desviación cubital. El Score de muñeca de mayo fue excelente en el 75%, Bueno en el 16,6%, Satisfactorio en el 8,33% y no hemos tenido malos resultados. Con respecto al Dash Score, el promedio en el pre operatorio fue de 81,5 puntos y en el Post operatorio a la fecha de 4,5 puntos. El promedio de la fuerza comparativa contralateral fue del 84%. Discusión: Mathoulin propone para evitar la rigidez y estabilizar el ligamento la Capsulodesis dorsal artroscópica, con la cual obtiene mejoría del dolor y movilidad satisfactoria por poco daño capsular en lesiones de García Elías 2,3 y 4 crónicas, basado en los estudios de Gajendran, Deshmukh, Brunelli y zarkadas sobre capsulodesis dorsal, donde obtuvieron rangos de movilidad menores a los pre quirúrgicos por el daño capsular creado, y evolucionaron a la artrosis en menos de 5 años por avance de lesión SLAC. Conclusión: La reparación artroscópica de las lesiones escafolunares Geissler I a IV, EWAS I a IIIc Y GARCIA ELIAS I a III dan resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor en alto porcentaje. Encontramos que el tiempo entre la cirugía y los resultados obtenidos influye en los resultados y cuanto mayor es el seguimiento mejor los resultados. Tipo de estudio: Serie de casos. Nivel de evidencia: IV


Objective: Our purpose of performing this retrospective work was to determine the function and objective results of patients with scapholunate lesions by modified arthroscopic dorsal type Mathoulin capsule. Methods: We evaluated 12 patients with scapholunate ligament injury, using the classification of Geissler, EWAS and García Elías. Nine men and 3 women were evaluated. 100% working age. The post-operative follow-up time was 7.8 months (4-12 months). Three of the patients were treated acutely (up to 2 months of pain or instability) and 9 patients were chronically (more than 3 months of pain or instability). All patients had dorsal scapholunate pain and a positive Watson test. All lesions were repaired with the modified arthroscopic technique of Dorsal Capsulodesis of Mathoulin. The Mobility Range (ROM), grip strength, May Wrist score and the DASH Score were evaluated. Results: We have had improvements in pain and strength tests, the average ROM was 71° for extension, 65 ° for flexion, 25 ° for radial deviation and 25 ° for ulnar deviation. The Wrist Score of May was excellent at 75%, Good at 16.6%, Satisfactory at 8.33% and we have not had bad results. With respect to the Dash Score, the average in the pre-operative was 81.5 points and in the Post-operative to the date of 4.5 points. The average of the contralateral comparative force was 84%. Discussion: Mathoulin proposes to avoid stiffness and stabilize the ligament arthroscopic dorsal Capsulodesis, with which it obtains pain improvement and satisfactory mobility for little capsular damage in García Elías 2,3 and 4 chronic lesions based on the studies of Gajendran, Deshmukh , Brunelli and zarkadas on dorsal Capsulodesis where they obtained lower mobility ranges than the pre-surgical ones due to the capsular damage created and evolved to osteoarthritis in less than 5 years due to progression of the SLAC lesion (one). Conclusion: The arthroscopic repair of scapholunate lesions Geissler I to IV, EWAS I to IIIc and GARCIA ELIAS I to III give satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain in high percentage. We found that the time between surgery and the results obtained influences the results and the greater the follow-up the better the results. Type of study: Number of cases. Level of evidence: IV


Subject(s)
Arthroscopy/methods , Wrist Injuries , Scaphoid Bone/injuries , Treatment Outcome
17.
Artrosc. (B. Aires) ; 26(3): 74-82, 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1048242

ABSTRACT

Introducción: El síndrome de pinzamiento cubito carpiano es una de las causas más frecuentes de dolor cubital de la muñeca. Es una patología de tipo degenerativa y progresiva. El objetivo del tratamiento quirúrgico se basa en la descompresión articular del cubito con el carpo proximal. Con los avances tecnológicos es posible realizar la osteotomía del cubito por via artroscópica y así tratar también lesiones asociadas. Material y Métodos: Evaluamos 13 pacientes con síndrome de impactación cubital desde el 01/01/2018 hasta el 01/03/19, utilizando la clasificación de Palmer para evaluar las lesiones. Evaluamos 7 mujeres y 6 hombres. La edad de los pacientes fue desde los 47-82 años (62 años promedio). El 69,2% en edad laboral (9 pacientes) y el 30,7% jubilados (4 pacientes) con un seguimiento de 3 a 12 meses (8,9 meses de promedio). Todos los pacientes fueron tratados por artroscopia. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, escala de Mayo de Muñeca y escala de DASH. Resultados: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue de 80° extensión, 80° de flexión, 30° para la desviación radial y 25° de desviación cubital. El Score de muñeca de mayo fue: excelente 8 pacientes (61,5%), bueno en 5 pacientes (38,4%) y un mal resultado (7,69). La fuerza comparativa final fue del 82%. El Dash Score preoperatorio fue de 87 puntos y en el Post operatorio de 5 puntos. Conclusión: La osteotomía de cubito tipo wafer o en oblea artroscópica da resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor siempre y cuando está bien indicada la cirugía. Tipo de estudio: Serie de casos. Nivel de evidencia: IV


Introduction: The ulnar carpal impingement syndrome is one of the most frequent causes of ulnar pain in the wrist. It is a pathology of degenerative and progressive type. The objective of surgical treatment is based on the joint decompression of the ulna with the proximal carpus. With technological advances, it is possible to perform the osteotomy of the ulna by arthroscopic route and thus also treat associated injuries. Material and Methods: We evaluated 13 patients with ulnar impaction syndrome from 01/01/2018 to 03/01/19 using the Palmer classification to evaluate the lesions. We evaluated seven women and six men. The age of the patients was from 47-82 years (62 years average). 69.2% of working age (9 patients) and 30.7% retired (4 patients) with a follow-up of 3 to 12 months (8.9 months on average). All patients were treated by arthroscopy. The Mobility Range (ROM), grip strength, Wrist May scale and DASH scale were evaluated. Results: We have had improvements in pain and strength tests, the average ROM was 80° extension, 80° flexion, 30° for radial deviation and 25° ulnar deviation. The Wrist Score of May was excellent 8 patients (61.5%), Good in 5 patients (38.4%) and a poor result (7.69). The final comparative strength was 82%. The preoperative Dash Score was 87 points and in the post-operative of 5 points. Conclusion: The osteotomy of ulnar type wafer or arthroscopic wafer gives satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain as long as surgery is well indicated. Type of study: Case series. Level of evidence: IV


Subject(s)
Middle Aged , Aged , Osteotomy/methods , Arthroscopy/methods , Ulna/surgery , Ulna/pathology , Wrist Injuries/surgery , Treatment Outcome
18.
Rev. chil. ortop. traumatol ; 59(2): 55-64, sept. 2018. ilus
Article in Spanish | LILACS | ID: biblio-946867

ABSTRACT

INTRODUCCIÓN: El fragmento dorso-ulnar (FDU) en la fractura intraarticular de radio distal es de especial importancia puesto que implica una alteración en la articulación radio-carpiana así como también en la articulación radio-ulnar distal (RUD), donde la incongruencia articular permanente puede generar secuelas a largo plazo. OBJETIVO: Proponer una clasificación del FDU, definiendo cuándo realizar el procedimiento quirúrgico con asistencia artroscópica, basado en una serie consecutiva de casos operados de fractura del radio distal estudiados con tomografía computada (TC). MÉTODO: Estudio descriptivo de una serie de casos de pacientes operados por fractura del radio distal entre enero del 2015 y diciembre del 2016. En base a eso, se elabora una clasificación del FDU y se sugiere un esquema de manejo específico. Se describe el FDU como aquel fragmento específico ubicado en la esquina dorso-ulnar de la carilla articular del radio distal, con compromiso de más del 30% de la superficie articular RUD y más de 5mm desde el borde ulnar hacia radial de la cortical dorsal del radio observado en el corte axial de la TC preoperatoria. Se considera un fragmento mayor (FM) cuando el rasgo de fractura compromete hacia radial hasta el tubérculo de Lister y se considera fragmento menor (Fm) cuando el rasgo no alcanza a comprometer el tubérculo de Lister. Nuestra propuesta de clasificación reconoce 4 tipos: tipo I (FM sin desplazamiento, en fracturas tipo C de la AO); tipo II (FM con desplazamiento, en fracturas tipo C de la AO); tipo III (Fm independiente del desplazamiento, en fracturas tipo C de la AO) y tipo IV (FM/Fm con desplazamiento, en fracturas tipo B2 de la AO). Esquema de manejo: Tipo I síntesis con placa bloqueada por abordaje palmar, sin obligación de asistencia artroscópica. Tipo II síntesis con placa bloqueada por abordaje palmar, con asistencia artroscópica requerida. Tipo III síntesis percutánea dorsal contornillo canulado, bajo asistencia artroscópica. Tipo IV síntesis dorsal con placa o tornillo mediante abordaje dorsal bajo visión directa o con asistencia artroscópica, usando portales artroscópicos volares. RESULTADOS: Se operaron 488 fracturas de radio distal durante el período mencionado; 375 fracturas clasificadas como tipo C de la AO. Del total operadas, solo 392 fracturas contaban con TC peroperatoria, que permitía evaluar la presencia del FDU, el cual estuvo presente en 127/392 de los casos (32,4%). Analizados por grupo, 38 casos presentaban fragmentos tipo I, 22 tipo II, 69 tipo III y 7 tipo IV. DISCUSIÓN: El FDU se presentó en un 32,4% de los casos evaluables por TC en nuestra serie. El manejo dirigido de este fragmento con asistencia artroscópica permitió una reducción anatómica con fijación estable específica de éste. CONCLUSIÓN: Proponemos una nueva clasificación del FDU basada en la TC preoperatoria que permite realizar un adecuado plan prequirurgico y abordar este fragmento de manera específica sugiriendo cuando utilizar asistencia artroscópica.


INTRODUCTION: The dorsal-ulnar fragment (DUF) in the distal radius fracture is of special importance since it implies an alteration in the radio-carpal joint as well as in the distal radio-ulnar joint (DRUJ), where permanent joint incongruence can generate long-term sequelae. OBJECTIVE: To propose a classification of the DUF, advising when to perform arthroscopic assistance, based on a consecutive series of operated cases of distal radius fracture studied with computed tomography (CT). METHODS: Descriptive study of a series of cases of patients operated of distal radius fracture between January 2015 and December 2016. We describe a classification of the DUF and suggest a specific treatment scheme. The DUF is described as that specific fragment located in the dorso-ulnar corner of the articular surface of the distal radius, which involves more than 30% of the articular surface of the DRUJ and more than 5mm of the ulnar edge of the dorsal cortex of the radius observed in the axial section of the preoperative CT. It is considered a major fragment (FM) when the fracture compromises the Lister tubercle and is considered a minor fragment (Fm) when it does not. Our classification recognizes 4 types of DUF: type I (FM without displacement, in type C fractures of the AO); Type II (FM with displacement, in type C fractures of the AO); Type III (Fm independent of displacement, in fractures type C of the AO) and type IV (FM/Fm with displacement, in fractures type B2 of the AO). Treatment scheme: Type I: synthesis with a palmar locked plate without arthroscopic assistance required. Type II: synthesis with palmar locked plate with arthroscopic assistance. Type III dorsal percutaneous synthesis with cannulated screw with arthroscopic assistance. Type IV dorsal synthesis with plate or screw by dorsal approach under direct vision or with arthroscopic assistance using volar portals. RESULTS: A total of 488 distal radius fractures were operated during this period. Only 392 fractures had preoperative CT, which allowed to evaluate the presence of the DUF. It was present in 127/392 of the cases (32.4%). Analyzed by group, 38 cases presented fragments type I, 22 cases type II, 69 cases type III and 7 cases type IV. DISCUSSION: The DUF was presented in 32.4% of the cases in our series. The management of this fragment with arthroscopic assistance allowed an anatomical reduction with specific stable fixation of this fragment. CONCLUSION: We propose a novel classification of the DUF based on preoperative CT that allows a specific management of this fragment and suggest when to use arthroscopic assistance.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Arthroscopy/methods , Radius Fractures/surgery , Radius Fractures/classification , Radius Fractures/diagnostic imaging , Ulna Fractures/surgery , Ulna Fractures/classification , Ulna Fractures/diagnostic imaging , Wrist Injuries/surgery , Preoperative Care , Range of Motion, Articular , Treatment Outcome , Fracture Fixation, Internal
19.
Article in Chinese | WPRIM | ID: wpr-691490

ABSTRACT

OBJECTIVE@#To obtain three-dimensional intraosseous artery of the hamate and to provide the vascular anatomy basis of hamate fracture fixation.@*METHODS@#PbO (lead monoxide, Sinopharm Chemical Reagent Beijing Co. Ltd) was ground into particles less than 40 μm and suspended in turpentine oil (Chemical Reagent Beijing Co. Ltd) at ratios of 1 g : 1.5 mL, 1 g : 1 mL and 1 g : 0.5 mL. Three specimens were investigated. Brachial arteries were cannulated and perfused with lead-based contrast agent. Hamates were harvested and scanned using micro-computed tomography (microCT). The acquisition protocols were as follows: CT scan setup: total rotation [Degrees], 360; rotation steps, 360; X-ray detector setup: transaxial, 2048; axial, 2048; exposure time, 1 500 ms, Binning, 1; system magnification: high-med. X-ray tube setup: 80 kV, 500 mA current. The down-sampling factor used in the reconstruction was 2. The effective voxel size of the final image was 27.30 μm. The three-dimensional model of the hamate was generated and the distribution and pattern of vessels were evaluated.@*RESULTS@#There were abundant extraosseous vessels around the hamate. They were mainly running in the tendons and ligaments around the hamate. Four vascular zones were identified on the hamate surface. They were on the palmar platform of the hamate body, on the dorsal side, on the ulnar side and on the tip of hamulus, namely. There were anastomoses among 4 vascular zones. We did not observe any vessels penetrating through the articular cartilage. The extraosseous vessels of the vascular zones gave a number of intraosseous branches into the hamate. The hamate body received intraosseous blood supply from the dorsal, palmar and ulnar while the hamulus from the palmar, ulnar and hamulus tip. There were some intraosseous branches anastomosing with each other.@*CONCLUSION@#The extraosseous and intraosseous vessels of the hamate were more than what used to be considered. The hamate body and hamulus received blood supply from multiple directions and arteries anastomosed extensively both outside and inside the hamate, making it possible that the intraosseous perfusion survived after fracture. It is likely that the nonunion after the hamate fracture is not caused by the vascular damage but the malalignment of the fragments.


Subject(s)
Beijing , Brachial Artery , Fluoroscopy , Fractures, Bone/diagnostic imaging , Hamate Bone/injuries , Humans , Ulna , Wrist Injuries/diagnostic imaging , X-Ray Microtomography
20.
Artrosc. (B. Aires) ; 25(2): 55-62, 2018. ilus, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-972511

ABSTRACT

INTRODUCCIÓN: Las Lesiones del Complejo Fibrocartílago Triangular (CFCT) son causa común de dolor Ulnar en la muñeca, la artroscopia es el estándar de oro para el diagnóstico y tratamiento de las mismas. Realizamos un trabajo retrospectivo evaluando la función y resultados de los pacientes operados con técnica artroscópica con la lesión CFCT Palmer 1B/Atzei 1. MATERIAL Y MÉTODO: Evaluamos 24 pacientes con 25 lesiones de CFCT palmer 1B/Atzei 1. El 88% en edad laboral entre 19 a 57 años (34 años promedio) con un seguimiento promedio de 9 meses. Todas las lesiones fueron reparadas con técnicas artroscópicas y puntos de sutura adentro afuera y afuera adentro. Se evaluó el Rango de Movilidad (ROM), fuerza de agarre, escala de Mayo de Muñeca y escala de DASH. RESULTADOS: Hemos tenido mejoras en test del dolor y la fuerza, el ROM promedio fue 70° para la extensión, 85° de flexión, 20° para la desviación radial y 30° de desviación cubital. El Score de muñeca de mayo fue excelente en el 64%, Bueno en el 16%, Satisfactorio en el 20% y no hemos tenido malos resultados. Nuestro Dash Score pre operatorio fue de 86 puntos y en el Post operatorio de 13 puntos. El promedio de la fuerza comparativa contralateral fue del 70%. CONCLUSIÓN: La reparación artroscópica de las lesiones Palmer 1B/ Atzei 1 dan resultados satisfactorios mejorando los ROM, recuperando la fuerza de forma total o parcial y disminuyendo el dolor. Encontramos que el tiempo entre la cirugía y los resultados obtenidos influye en los resultados y cuanto mayor es el seguimiento mejor los resultados. Tipo de estudio: Serie de casos. Nivel de evidencia: IV.


OBJECTIVE: Lesions of the Triangular Fibrocartilage Complex (CFCT) are a common cause of ulnar pain in the wrist; arthroscopy is the gold standard for the diagnosis and treatment of them. We performed a retrospective study evaluating the function and results of patients operated with an arthroscopic technique with Palmer 1B / Atzei 1 lesion. MATERIAL AND METHODS: We evaluated 24 patients with 25 CFCT lesions palmer 1B / Atzei 1. 88% of working age between 19 to 57 years old (average 34 years) with a follow-up of 9 months. All injuries were repaired with arthroscopic techniques and stitches inside and outside inside. The Mobility Range (ROM), grip strength, May Wrist score and the DASH Score were evaluated. RESULTS: We have had improvements in pain and strength tests, the average ROM was 70 ° for extension, 85 ° for flexion, 20° for radial deviation and 30 ° for ulnar deviation. The Wrist Score of May was excellent at 64%, Good at 16%, Satisfactory at 20% and we have not had bad results. Our preoperative Dash Score was 86 points and in the Post-operative of 13 points. The average of the contralateral comparative force was 70%. CONCLUSION: The arthroscopic repair of the Palmer 1B / Atzei 1 lesions gives satisfactory results improving the ROM, recovering the strength totally or partially and decreasing the pain. We found that the time between surgery and the results obtained influences the results and the greater the follow-up the better the results. Type study: Number of cases. Level of evidence: IV.


Subject(s)
Adult , Arthroscopy/methods , Triangular Fibrocartilage/injuries , Triangular Fibrocartilage/surgery , Wrist Injuries/surgery , Wrist Joint/surgery , Pain Measurement , Range of Motion, Articular , Treatment Outcome
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