Reconstrucción por técnica de Chevron reverso y transferencia tendinosa con técnica no convencional en Hallux Varus Iatrogénico Severo / Reconstruction by reverse Chevron technique and tendon transfer with unconventional technique in severe iatrogenic Hallux Varus

El Hallux Varus Iatrogénico es una complicación de la cirugía correctiva del Hallux Valgus muy poco frecuente. El tratamiento incluye la intervención de los tejidos blandos, y óseos. El propósito de este trabajo es mostrar los resultados clínico-radiológicos del tratamiento quirúrgico del Hallux Varus Iatrogénico Flexible Severo empleando la combinación de técnicas de reconstrucción alternativas en una paciente femenina de 59 años de edad. Se realizó liberación medial de la capsula articular MTF y abductor, osteotomía de Chevron reverso, artrodesis interfalángica izquierda, transferencia tendinosa del extensor largo de Hallux hacia plantar con botón artesanal. De acuerdo a la Escala AOFAS aumentó de 30 a 90 puntos. Se logró la corrección estable de la deformidad en varo y la consolidación de la osteotomía. El Hallux Varus Iatrogénico es una complicación poco frecuente considerada una deformidad mal tolerada, con pocos casos reportados y pocos reportes. Se debe hacer un enfoque de tratamiento paso a paso para abordar todos los elementos involucrados en el Hallux Varus iatrogénico. La corrección quirúrgica del Hallux Varus iatrogénico severo con técnicas de reconstrucción no convencionales tipo Chevron reverso y transferencia tendinosa con botón plantar, es una excelente opción terapéutica de acuerdo a los resultados obtenidos en este caso(AU)

Iatrogenic Hallux Varus is a very rare complication of Hallux Valgus corrective surgery. The treatment includes the intervention of soft tissues and bones. The purpose of this paper is to show the clinical-radiological results of the surgical treatment of Severe Flexible Iatrogenic Hallux Varus using the combination of alternative reconstruction techniques in a 59-year-old female patient. Medial release of the MTF and abductor joint capsule, reverse Chevron osteotomy, left interphalangeal arthrodesis, tendon transfer of the long extensor of Hallux to plantar with artisanal button was performed. According to the AOFAS Scale, it increased from 30 to 90 points. Stable correction of the varus deformity and consolidation of the osteotomy were achieved. Iatrogenic Hallux Varus is a rare complication considered a poorly tolerated deformity, with few reported cases and few reports. A step-by-step treatment approach must be taken to address all the elements involved in iatrogenic Hallux Varus. Surgical correction of severe iatrogenic Hallux Varus with unconventional reconstruction techniques such as reverse Chevron and plantar button tendon transfer is an excellent therapeutic option according to the results obtained in this case(AU)

Momificación natural de falanges como consecuencia de meningococemia fulminante. A propósito de un caso / Natural mummification of phalanges as a consequence of fulminant meningococcemia. About a case

Fundamento: Las infecciones del sistema nervioso central constituyen una importante causa de morbilidad y mortalidad neurológica. La púrpura fulminante o meningococemia es una enfermedad grave que evoluciona a severas complicaciones y secuelas, sin embargo, es infrecuente que ocurra momificación o amputación natural de los dedos de las manos y los pies. Objetivo: Describir el caso de un paciente con meningococemia fulminante, al cual se le momificaron de manera natural las falanges de las manos y los pies como consecuencia de la enfermedad. Presentación del caso: Se presenta un paciente de 18 años de edad que fue diagnosticado con meningococemia. Clínicamente presentó fiebre, cefalea intensa, lesiones purpúrico hemorrágicas, petequias y hematomas en piel, evolutivamente shock séptico y disfunción múltiple de órganos. Posterior a 16 días de estadía en sala egresó vivo del hospital, pero con secuelas caracterizadas por momificación de las falanges de las manos y los pies. Conclusiones: La meningococemia es una enfermedad aguda, potencialmente mortal y se reporta mayormente en la edad pediátrica. Entre los sobrevivientes es infrecuente que ocurra la momificación de las falanges de las manos y los pies, como ocurrió en el caso reportado.

Background: Infections of the central nervous system are a significant cause of neurological morbidity and mortality. Purpura fulminans or meningococcemia is a serious disease that evolves into severe complications and sequelae, however it is infrequent for mummification or natural amputation of fingers and toes to occur. Objective: To describe the case of a patient with fulminant meningococcemia, in whom hands and feet phalanges were naturally mummified as a consequence of the disease. Case report: An 18-year-old patient diagnosed with meningococcemia is presented. Clinically, he presented fever, intense headache, purpuric hemorrhagic lesions, petechiae and bruises on the skin, progressively septic shock and multiple organ dysfunction. After 16 days in hospital, he was discharged alive, but with some sequelae characterized by mummification of the hands and feet phalanges. Conclusions: Meningococcemia is an acute, life-threatening disease and is mostly reported in the pediatric age. Mummification of the hands and feet phalanges is uncommon among survivors, as occurred in the reported case.

Relação espacial entre o estojo córneo e a falange distal em éguas Campolina adultas com e sem obesidade / Spatial relationship between the hoof capsule and the distal phalanx in adult Campolina mares with and without obesity

A laminite endocrinopática tem acometido um número crescente de equinos com sinais de obesidade. Em um estudo recente com fêmeas jovens (até cinco anos) da raça Campolina, demonstraram-se indícios de alterações no dígito, ainda discretas, aparentemente associadas ao aumento da adiposidade. Com a hipótese de que essa associação é mais evidente em animais em faixa etária superior, o objetivo do presente estudo foi estudar éguas adultas (acima de cinco anos) da raça Campolina com e sem obesidade, avaliando-se radiograficamente a relação espacial entre estojo córneo e falange distal. Foram utilizadas 27 éguas entre seis e 14 anos de idade, sendo analisadas variáveis de adiposidade e medidas radiográficas dos cascos dos membros torácicos de equinos com escore corporal de 5 a 7/9 (grupo controle) e de 8 a 9 (grupo obeso). Foram feitas comparações entre os grupos e correlacionaram-se as variáveis de adiposidade com variáveis casco. A distância de afundamento da falange distal foi cerca de 20% superior nas éguas obesas (12,3±2,5 contra 10,2±2,2mm no grupo controle). Esse parâmetro também correlacionou (P<0,01) com vários parâmetros de adiposidade, com destaque para o escore de condição corporal (r=0,47) e a circunferência de pescoço a 75% (r=0,42). Os resultados corroboram estudos prévios que demonstraram associação entre obesidade e indícios de separação entre falange distal e estojo córneo em equinos de raças nacionais, comprovando, assim, a utilidade da avaliação radiográfica nesses animais. Em conclusão, éguas da raça Campolina com obesidade possuem alterações evidentes na relação espacial entre estojo córneo e falange distal, que se intensificam com o aumento da idade e da adiposidade.(AU)

In a recent study with young females (up to 5 years old) of the Campolina breed, there were discrete indications of alterations in the digit, apparently associated to the increase in adiposity. With the hypothesis that this association is more evident in horses in the upper age group, the objective was to study Campolina adult mares (above 5 years) with and without obesity, evaluating radiographically the spatial relationship between the horn and distal phalanx. Eighteen mares between six and fourteen years and with a body score of 5 to 7/9 (Control Group) and 8 to 9 (Obeso Group) were used. Adiposity and radiographic measurements from the forelimbs were analyzed. Comparisons were made between groups and adiposity variables were correlated with hoof variables. The sinking distance of the distal phalanx was about 20% higher in obese mares (12.3±2.5 versus 10.2±2.2mm). This parameter also correlated (P< 0.01) with several adiposity parameters, with emphasis on body score condition (r= 0.47) and neck circumference at 75% (r= 0.42). In conclusion, Campolina mares with obesity have obvious alterations in the spatial relation between the corneal and the distal phalanx, which get intense according to increases in age and adiposity.(AU)

Relação espacial entre a falange distal e o estojo córneo em éguas Campolinas jovens com e sem sinais de obesidade / Spatial relationship between the distal phalanx and the hoof capsule in young Campolina mares with and without obesity

Estudos prévios têm demonstrado alterações radiográficas em cascos de equinos obesos. Os objetivos foram estudar, com avaliação radiográfica, a relação espacial entre estojo córneo e falange distal de éguas jovens da raça Campolina com e sem obesidade. Foram utilizadas 22 éguas entre três e cinco anos de idade, sendo analisadas varáveis de adiposidade e medidas radiográficas dos cascos dos membros torácicos de éguas com escore corporal de 5 a 7/9 (Grupo Controle) e de 8 a 9 (Grupo Obeso). Foram feitas comparações entre os grupos e correlacionaram-se as variáveis de adiposidade entre si, variáveis adiposidade com variáveis casco e variáveis de casco entre si. Utilizou-se o teste t de Student para variáveis paramétricas e o teste Mann-Whitney para as não-paramétricas, para as medidas de correlação, utilizou o teste de Pearson para duas amostras paramétricas e o teste de Spearman para comparações que envolvam pelo menos uma variável não paramétrica (P<0,05). Os resultados demonstraram que éguas Campolinas obesas, ainda jovens, já apresentam indícios de alteração na relação espacial entre estojo córneo e falange distal.(AU)

Previous studies have demonstrated radiographic changes in the hoof of obese horses. The objective was to study through radiographic evaluation the spatial relationship between the hoof capsule and the distal phalanx of Campolina mares with and without obesity. Twenty-two Campolina mares 3 to 5 years old were used. We analyzed adiposity variables and radiographic measurements of the hoof of both forelimbs of mares with body condition score from 5 to 7/9 (Control group) and from 8 to 9 (Obese group). Comparisons were made between groups using the Student t test for parametric variables and the Mann-Whitney test for the nonparametric ones. Pearson or Spearman tests were used to evaluate the correlation among parametric and nonparametric variables respectively (P<0.05). Evidences of changes in the spatial relationship between the hoof capsule and the distal phalanx were observed in obese Campolina young mares.(AU)

Tricoblastoma de localización acral, una ubicación infrecuente: reporte de un caso / Acral location trichoblastoma, a location infrequent: report of a case

Tricoblastoma es una neoplasia anexial benigna de la piel, de difícil diagnóstico clínico, por su baja prevalencia y por la ausencia de características clínicas patognomónicas. Por esta razón, es la biopsia la que hace el diagnóstico definitivo, ya que se suele confundir con otras neoplasias anexiales. Se presenta caso clínico de una mujer de 87 años con historia de cinco años de evolución de lesión nodular, sésil y simétrica ubicada en la falange proximal del primer ortejo del pie izquierdo, la cual había presentado un crecimiento progresivo en los últimos seis meses, refiriendo molestias leves con el calzado, sin mayores complicaciones. La biopsia excisional de la lesión, es informada como tricoblastoma. El escaso conocimiento del tricoblastoma lleva a la incorrecta interpretación de su forma clínica, lo que resulta relevante, pues su principal diagnóstico diferencial corresponde al carcinoma basocelular (CBC). Se presenta el caso clínico por lo infrecuente de su localización, lo que indujo a confusión del diagnóstico. No se debe olvidar que el tricoblastoma es una neoplasia anexial benigna, que puede presentarse en cualquier sitio en el que existan folículos pilosebáceos, por lo que hay que considerarlo dentro de los diagnósticos diferenciales de cualquier neoplasia anexial.

Trichoblastoma is a skin benign adnexal neoplasm, clinical diagnosis is difficult because presents a low prevalence, it has not any pathognomonic clinical characteristics and it's often mistaken with other adnexal tumors; so the biopsy makes the definitive diagnosis. We report the case of a woman of 87 years with a history of 5 years of evolution of a nodular, sessile and symmetrical lesion located in the proximal phalanx of the first left toe, which had presented a progressive growth in the last 6 months, she presented mild discomfort with footwear, without major complications. The excisional biopsy of the lesion, was reported as a trichoblastoma. Poor knowledge of trichoblastoma leads to a clinical misinterpretation, which is relevant, because its main differential diagnosis corresponds to basal cell carcinoma (BCC). A case located on an extremely rare location is presented, which led to confusion in clinical diagnosis. You must not forget that trichoblastoma is an adnexal benign tumor, which can occur at any site with pilosebaceous follicles, so we should consider in the differential diagnoses of any skin adnexal neoplasms.

Osteology and radiographic anatomy of the hind limbs in Marshdeer (Blastocerus dichotomus) / Anatomia óssea e radiográfica do membro pélvico do cervo-do-pantanal (Blastocerus dichotomus)

The knowledge of anatomical structures found in wild animals is important for the practice of medical and surgical clinic. Thus, the aim of this study was to describe the osteology and radiographic anatomy of the femur, patella, tibia, fibula, tarsal, metatarsal and phalanges of the Marshdeer Blastocerus dichotomus as a reference for clinical use and species identification. Most structures were similar to those found in domestic animals, with special features of this species. Noteworthy is, for example, the absence of the third trochanter of the femur. Although a ruminant, the Marshdeer has a fibuyla similar to the one described for the horse. B. dichotomus has four fingers on each limb, formed through three phalanges, only the third and fourth finger touch the ground, and the second and fifth finger is rudimentary. It has four proximal and two distal sesamoid bones, and sesamoid bones near the gastrocnemius muscle do not exist...

O conhecimento das estruturas anatômicas encontradas nos animais silvestres é importante para a prática da clínica médica e cirúrgica. O objetivo deste trabalho foi descrever a osteologia e anatomia radiográfica do fêmur, patela, tíbia, fíbula, tarsais, metatarsais e falanges do cervo-do-pantanal, para contribuir com o cotidiano clínico e, a identificação da espécie. A maioria das estruturas foi semelhante às encontradas nos animais domésticos, com particularidades próprias da espécie. Destaca-se, por exemplo, a ausência do terceiro trocanter do fêmur. Embora seja um ruminante, o cervo-do-pantanal apresentou a fíbula semelhante à descrita para os equinos. Este animal possui quatro dedos em cada membro, formados por três falanges, sendo que apenas o terceiro e o quarto dedos tocam o solo e, o segundo e o quinto dedos são rudimentares. Apresentou ainda quatro ossos sesamóides proximais e dois distais. Não se observou ossos sesamóides junto ao músculo gastrocnêmio...

Analysis of the difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate difference between the appearance and the bony structure in the polysyndactyly of the fifth toe fused with the fourth toe.</p><p><b>METHODS</b>From Jan. 2009 to Jan. 2014, 54 patients (65 feet) with polysyndactyly of the fifth toe fused with the fourth toe were treated. The appearance, X-ray and intraoperative finding were recorded and compared to classify the deformity. Then the extra toe was excised and syndactyly was separated. The malalignment and brachydactyly of the sixth toes were corrected simultaneously.</p><p><b>RESULTS</b>According to the bone and joint type, the fifth toes were neoplastic toes without joints in 17 feet, or had poor bony and joint alignment with the sixth toes in 48 feet. So the fifth toes were excised in all the cases. The patients were followed up for 1 month to 4 years. The oblique deformity of sixth toes were corrected completely with improved length.</p><p><b>CONCLUSIONS</b>The polysyndactyly of the fifth toe fused with the fourth toe should be classified to design the excised toe (usually fifth toe) and correction procedure. The appearance and bony joint recovery are both important.</p>

Fibromatose digital infantil: relato de caso / Infantile digital fibromatosis: case report

Introdução: A fibromatose digital infantil é uma proliferação nodular, assintomática, rara e benigna do tecido fibroso, que ocorre quase exclusivamente na região dorsal e lateral dos dedos das mãos e pés. O artigo relata um caso de fibromatose digital infantil, também conhecida como tumor de Reye. Relato de Caso: Trata-se de um caso diagnosticado por meio de exames clínico, de imagem e histopatológico. O paciente apresentou-se ao Setor de Ortopedia do Hospital, queixando-se de uma lesão nodular, eritematosa, indolor, no segundo pododáctilo do pé esquerdo, existente havia quatro anos. Durante o exame físico, notava-se uma deformidade no II pododáctilo, causada por uma lesão nodular, eritematosa, indolor, de aproximadamente 1,5 cm, que não acarretava alterações funcionais. O exame de ultrassom revelou a presença de uma imagem nodular sólida, hipoecogênica, envolvendo o tendão do extensor do II pododáctilo na falange média. O diagnóstico inicial era de fibroma ou sinovioma. Pelas características clínicas da lesão, por seu tempo de evolução e pelos achados de imagem, a equipe optou por uma biópsia. No entanto, devido ao pequeno tamanho da lesão, sendo a biópsia aberta, realizou-se a exérese cirúrgica. O exame histopatológico confirmou o diagnóstico de fibromatose digital infantil. Conclusão: Esse tumor constitui uma entidade clínica rara, que deve ser diferenciada de outras lesões encontradas nos dedos das mãos e dos pés. O diagnóstico correto raramente é feito antes da operação, devido, principalmente, à falha em reconhecer essa entidade. Por essa razão, é essencial considerar essa lesão em diagnósticos diferenciais.

Introduction: Infantile digital fibromatosis, also known as Reye tumor, is a rare, asymptomatic, benign nodular proliferation of fibrous tissue, which occurs almost exclusively in the dorsolateral region of the fingers and toes. This article reports a case of infantile digital fibromatosis. Case report: This case was diagnosed by clinical, imaging, and histopathological examination. The patient presented at the rthopedic Department of our hospital, with a 4-year history of a painless, erythematous nodular lesion on the econd toe of the left foot. On physical examination, a deformity of the second toe caused by a nodular, erythematous, painless lesion of approximately 1.5 cm diameter was noted; the lesion did not result in functional changes. Ultrasound examination revealed a solid, hypoechoic nodule involving the extensor tendon in the middle phalanx of the second toe. The initial diagnosis was fibroma or synovioma. Due to the clinical characteristics of the lesion, its evolution, and the imaging findings, the team chose to perform a biopsy. However, due to the small size of the lesion, upon open biopsy, surgical excision was performed. Histopathological examination confirmed the diagnosis of infantile digital fibromatosis. Conclusion: Infantile digital fibromatosis is a rare clinical entity, which should be differentiated from other lesions found in the fingers and toes. The correct diagnosis is rarely made pre-operatively, due mainly to a failure to recognize this entity. For this reason, it is essential to onsider this lesion in the differential diagnosis of digital nodules.

Osteotomía en Scarf: estudio de 25 casos / Scarf osteotomy: a report of 25 cases

Evaluar los resultados clínicos y radiográficos de la osteotomía en Scarf para el tratamiento del hallux valgas moderado-severo. Material y métodos: Realizamos un estudio retrospectivo con 25 osteotomías en Scarf realizadas desde marzo de 2009 a junio de 2011 con un seguimiento medio de 11 meses para el tratamiento del hallux valgus moderado-severo. Se realizó una valoración clínica de forma pre y postoperatoria según la escala funcional de la American Orthopaedic Foot and Ankle Society (AOFAS) y una valoración radiográfica, mediante la medición de los ángulos intermetatarsiano (IMA), de hallux valgus (HVA) y distal de la articulación metatarsofalángica (DMAA), también de forma pre y postoperatoria. Resultados: En el estudio, 19 pacientes fueron mujeres y 6 hombres, siendo la edad media de 45 años. La estancia media de ingreso fue de 1.2 días. Según la escala AOFAS, se obtuvo una puntuación global preoperatoria de 34.44 y postoperatoria de 92.4. En cuanto a los resultados radiológicos postoperatorios, obtuvimos un IMA medio de 8.84° y un HVA medio de 18.2°. El DMAA fue menor de 10° excepto en 1 paciente. Conclusión: La osteotomía en Scarf ofrece al paciente un apoyo temprano, una movilidad metatarso-falángica precoz y una rápida consolidación de la osteotomía. Obtuvimos unos buenos resultados a corto-medio plazo para el tratamiento del hallux valgus moderado-severo(AU)

To assess the clinical and radiographic results of the Scarf osteotomy in the treatment of moderatesevere hallux valgus. Patients and methods: We performed a retrospectiva study of 25 Scarf osteotomies from March 2009 to June 2011 with an average follow up of 11 months for the treatment of the moderate-several hallux valgus. We assessed the clinical outcome pre and postoperative according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale and radiological outcome, with measuring the angles intermetatarsal (IMA), of hallux valgus (HVA) and distal of metatarsal-phalang joint (DMAA), pre and postoperative. Results: In the study, 19 patients were women and 6 men with average age of 45 years. Tbe average stay of revenue was 1.2 days. According to the AOFAS scale, we obtained a global preoperative score of 34.44 and postoperative of 92.4. About the postoperative radiological findings, we obtained an average IMA of 8.84° and HVA of 18.2 °. Ttle DMAA was less than 10° except in 1 patient. Conclu ion: The Scarf osteotomy offers an early load, an early metatarsal-phalang joint mobility and an early osteotomy consolidation. We performed a good results in the short-medium term for the treatment of the moderate-severe hallux valgus(AU)

A case of peripheral gangrene and osteomyelitis secondary to terlipressin therapy in advanced liver disease

Variceal bleeding and hepatorenal syndrome (HRS) are serious and life-threatening complications of advanced liver disease. Terlipressin is widely used to manage both acute variceal bleeding and HRS due to its potency and long duration of action. The most severe (though rare) adverse event is ischemia. The present report describes the case of a patient with gangrene and osteomyelitis secondary to terlipressin therapy. A 71-year-old male with alcoholic liver cirrhosis (Child-Pugh B) and chronic hepatitis C was admitted due to a drowsy mental status. The patient had several experiences of orthopedic surgery. His creatinine level had gradually elevated to 4.02 mg/dL, and his urine output decreased to 500 mL/24 hr. The patient was diagnosed as having grade III hepatic encephalopathy (HE) and type II HRS. Terlipressin and albumin were administered intravenously to treat the HRS over 11 days. Although he recovered from the HE and HRS, the patient developed peripheral gangrene and osteomyelitis in both feet. His right toes were cured with the aid of rescue therapy, but his left three toes had to be amputated. Peripheral gangrene and osteomyelitis secondary to terlipressin therapy occur only rarely, and there is no specific rescue therapy for these conditions. Thus, attention should be paid to the possibility of ischemia of the skin and bone during or after terlipressin therapy.

Big toe metastases as first clinical sign of occult bronchogenic carcinoma

Metastasis to bone is a common manifestation of malignant tumours. However, metastasis to the bones of the foot is exceedingly rare. It usually arise from genitourinary tract and colon, with the tarsal bones accounting for half of all metastases. We report a rare case of pain and destruction of the distal phalanx of great toe, initially suspected as osteomyelitis, which on biopsy proved to be metastases from a clinically silent bronchogenic carcinoma

Exostosis subungueal en un adolescente de 14 años / Subungual exostosis in a 14 yaears old boy

La exostosis subungueal es un tumor benigno de hueso trabecular rodeado por una cápsula fibrocartilaginosa; aparece principalmente en la falange distal del hallux, por debajo de la uña o adyacente a ella y se manifiesta clínicamente por alteración de la uña suprayacente o de los tejidos blandos periunguales, respectivamente. Es infrecuente en la infancia y más común en el sexo femenino. La sospecha clínica se confirma por el hallazgo radiológico (placa de perfil) de una excrecencia de hueso trabecular que se proyecta desde la superficie dorsal de la falange distal del dedo afectado. El tratamiento de elección consiste en el legrado o remoción quirúrgica de la lesión. Presentamos un caso de exostosis subungueal localizada en el halllux en un varón de 14 años de edad, con la tríada característica de esta entidad: dolor digital, lesión subungueal con deformidad de la lámina ungueal y hallazgos radiográficos característicos.

[ case report of disappearing bone disease of the 1[st] metatarsus]

Disappearing Bone Disease is a rare vascular tumor. The presented case is a 15-year old boy with deformity of the 1st metatarsus in right foot who had a history of mild trauma. In X-Ray examination the proximal phalanx was absent. In the surgery, proximal phalanx was replaced by fibula bone and biopsy was done. After 15 months in follow up radiography osteolystic lesions in the 1[st] and 2[nd] metatarsus of right foot were observed. Due to severe pain and with the diagnosis of disappearing bone disease, the patient underwent radiotherapy. After radiotherapy, in control X-Ray of the right foot, osteolystic lesions of the 2[nd] metatarsus had been completely absorbed

Tratamiento quirúrgico en braquisindactilia: formación de pinza eficiente / Surgical treatment in braquisindactily: building a useful forceps

The therapy for hand malformations is challenging especially in aphalangia in symbrachydactyly. Ten cases of symbrachydactyly are presentd which are seek to obtain a useful forceps of the hand, treated with two surgical techniques: I. Resection of nubbins and Z-plasties of the interdigital space II. Nonvascularized extraperiostic graft of the first phalanx of the fourth toe to a beam of the hand. Surgical techniques, complications and resultd are described.

El tratamiento de las malformaciones congénitas de mano es un desafío especialmente en braquisindactilia. Se presentan 10 casos de braquisindactilia en los cuales se busca conseguir una pinza útil en la mano, tratados con dos técnicas quirúrgicas: 1. Resección de los mamelones digitales y zetoplastias del espacio interdigital logrado. II. Injerto extra perióstico no vascularizado de la 1° falange del 4° ortejo a un rayo de la mano. Se describe la técnica quirúrgicas, sus complicaciones y resultados.