Resultados del tratamiento del sindrome de impactación ulnar mediante procedimiento de Wafer artroscópico / Treatment of ulnar carpal impingement syndrome. Arthroscopic Wafer procedure. Results

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

Osteosarcoma parostal desdiferenciado en diáfisis de cúbito metastásico a pulmón / Dedifferentiated diaphyseal juxtacortical osteosarcoma of ulna with metastasis to the lung

Resumen: El osteosarcoma parostal desdiferenciado es una variante en la cual un osteosarcoma de alto grado coexiste con un osteosarcoma parostal. Se presenta el caso de un paciente femenino de 20 años; acudió con seis meses de evolución de dolor y limitación funcional en el antebrazo derecho sin causa aparente; se le realizaron radiografías, donde se observó una lesión tumoral en la diáfisis del cúbito derecho. A la exploración física, presentó dolor a la palpación en la diáfisis del cúbito y limitación a la pronosupinación. La tomografía axial computada de tórax reveló enfermedad metastásica en el lóbulo superior del pulmón izquierdo. Se le efectuó una biopsia incisional de la tumoración en el cúbito derecho, con reporte de osteosarcoma parostal desdiferenciado. Por ello, inició manejo con quimioterapia neoadyuvante con cisplatino y doxorrubicina hasta completar tres ciclos. El tratamiento quirúrgico consistió en resección intercalar de la diáfisis del cúbito derecho más reconstrucción de injerto autólogo microvascularizado de la diáfisis del peroné derecho y estabilización del injerto con placa de compresión dinámica (DCP) 3.5 mm y placa tercio de caña. En el mismo procedimiento se le efectuó metastasectomía pulmonar por toracoscopía. El reporte histopatológico postquirúrgico, con necrosis de 100%. Actualmente, la paciente se encuentra asintomática, sin datos de actividad tumoral. El osteosarcoma parostal desdiferenciado es una patología rara, pero que se debe sospechar como diagnóstico diferencial ante un osteosarcoma parostal; se debe tener en cuenta que esta enfermedad puede generar metástasis por su patrón desdiferenciado. Es importante planificar un tratamiento quirúrgico que permita una adecuada reconstrucción funcional, siempre teniendo en cuenta el principio oncológico.

Abstract: Dedifferentiated parosteal osteosarcoma is a variant in which a high grade osteosarcoma coexists with a parosteal osteosarcoma. We report the case of a 20-year-old female patient who presented with six months of evolution of pain and functional limitation of the right forearm, with no apparent cause; radiographs were performed, observing a tumoral lesion in the diaphysis of the right ulna. Physical examination showed pain upon palpation in the diaphysis of the ulna and limitation of prone-supination. Axial computed tomography of the thorax revealed metastatic disease in the upper lobe of the left lung. An incisional biopsy was performed on the right ulna, with a report of dedifferentiated parosteal osteosarcoma. Therefore, the patient was managed with neoadjuvant chemotherapy with cisplatin and doxorubicin until completing three cycles. Surgical treatment consisted of intercalary resection of the diaphysis of the right ulna, plus reconstruction of the microvascularized autologous graft of the right fibular diaphysis and graft stabilization with 3.5 mm dynamic compression plate (DCP) and one-third tubular plate. In the same procedure, pulmonary metastasectomy was performed by thoracoscopy. Post-surgical histopathological report with 100% necrosis. Currently, the patient is asymptomatic, with no evidence of tumor activity. Dedifferentiated parosteal osteosarcoma is a rare pathology, but should be suspected as a differential diagnosis in the presence of a parosteal osteosarcoma; it should be taken into account that this disease can metastasize due to its dedifferentiated pattern. It is important to plan a surgical treatment that allows an adequate functional reconstruction, always taking into account the oncological principle.

Deformidad de Madelung: presentación de un caso / Madelung deformity: case report

La deformidad de Madelung es una alteración poco común de la articulación de las muñecas, con una prevalencia desconocida por los pocos casos reportados hasta la actualidad. Se vincula a mutaciones del gen SHOX. Se caracteriza por presentar alteraciones en el radio, el carpo y el cúbito, con predominio bilateral. Afecta principalmente a pacientes de sexo femenino; los signos y síntomas se revelan al inicio de la adolescencia. Presentamos el caso clínico de una paciente de sexo femenino de 17 años que registra las manifestaciones clínicas y radiográficas características. (AU)

Madelung deformity is a rare alteration of the wrist joint of unknown prevalence due to the few cases reported. It has been linked to SHOX gene mutations. Madelung deformity is characterized by alterations of the radius, carpus and ulna, predominantly bilateral and mainly seen in female patients at the beginning of the adolescence. We report the clinical case of a 17-yearold female patient presenting the characteristic clinical and radiographic deformities. (AU)

Chronic recurrent multifocal osteomyelitis exhibiting predominance of periosteal reaction / Osteomielite crônica multifocal recorrente exibindo predomínio de reação periosteal

Summary Chronic recurrent multifocal osteomyelitis is an idiopathic nonpyogenic autoinflammatory bone disorder involving multiple sites, with clinical progression persisting for more than 6 months and which may have episodes of remission and exacerbation in the long term. It represents up to 2-5% of the cases of osteomyelitis, with an approximate incidence of up to 4/1,000,000 individuals, and average age of disease onset estimated between 8-11 years, predominantly in females. The legs are the most affected, with a predilection for metaphyseal regions along the growth plate. We describe the case of a female patient, aged 2 years and 5 months, with involvement of the left ulna, right jaw and left tibia, showing a predominance of periosteal reaction as main finding.

Resumo Osteomielite crônica multifocal recorrente é uma desordem autoinflamatória óssea idiopática não piogênica, envolvendo vários sítios e com evolução clínica persistindo por mais de 6 meses, podendo apresentar episódios de remissão e exacerbação em longo prazo. Representa de 2 a 5% das osteomielites, com incidência aproximada de até 4/1.000.000, com idade média de apresentação estimada entre 8 e 11 anos, predominando no gênero feminino. Os membros inferiores são os mais afetados, com predileção para regiões metafisárias junto à fise. Descrevemos um caso da doença em uma menina de 2 anos e 5 meses de idade, com acometimento de ulna esquerda, mandíbula à direita e tíbia esquerda, exibindo predomínio de reação periosteal como achado principal.

Formación de un solo hueso en antebrazo, en pseudoartrosis infectada de cúbito proximal / Formation of a single bone in the forearm in infected pseudoarthrosis of the proximal ulna

Propósito: Presentar el resultado exitoso de la técnica de formación de un solo hueso en antebrazo en un paciente con fractura inicial de cúbito con múltiples osteosíntesis e injertos fallidos. Caso: Paciente masculino dedicado a labores del campo que, a los 39 años de edad, sufre fractura de cúbito izquierdo, después de una evolución de 13 años y 5 intervenciones quirúrgicas con diversos tipos de osteosíntesis e injertos fallidos, que finalizaron en seudoartrosis infectada de cúbito izquierdo, decidiendo efectuarle la formación de un solo hueso en antebrazo evolucionando satisfactoriamente en función. Actualmente: supinación de 20º de antebrazo, flexoextensión de codo y muñeca completas, fuerza muscular adecuada, actualmente integrado en su trabajo de campo sin limitaciones funcionales. Conclusión: La técnica de formación de un solo hueso en antebrazo es, en casos adecuadamente seleccionados, una excelente alternativa de cirugía de reconstrucción o de salvamento en extremidad torácica.

Purpose: To present the successful results of the single-bone reconstruction technique in the forearm in a patient who sustained an ulnar fracture and underwent multiple osteosyntheses and failed grafts. Case: Male patient, agricultural worker, who at age 39 sustained a left ulnar fracture. After 13 years and 5 surgeries involving different types of osteosyntheses and failed grafts, which resulted in infection of the left ulnar pseudoarthrosis, we decided to do a single-bone reconstruction of the forearm. He did well and achieved good function. His current status is: 20º of forearm supination, full elbow and wrist flexion and extension, appropriate muscle strength, and he returned to his job without functional limitations. Conclusion: The single-bone forearm reconstruction technique is, in properly selected cases, an excellent surgical alternative when reconstruction or salvage of the thoracic limb is required.

A Case of an Idiopathic Massive Osteolysis with Skip Lesions

A patient with a 2-year history of pain in the left arm, and decreased strengths unrelieved by non-steroidal anti-inflammatory therapy, was being referred for repeating radiography. The radiologic examinations have demonstrated a unique pattern of non-contiguous osteolysis in the left elbow, proximal and distal radius, ulna, wrist, carpal bones, proximal and distal metacarpals and phalanges. Multi-site biopsies were being performed and confirmed the diagnosis of massive osteolysis. To our knowledge, this is the first case in which multifocal, non-contiguous osteolysis with skip lesions without associated nephropathy and without a hereditary pattern is being described in one extremity.

One-Bone Forearm Procedure for Acquired Pseudoarthrosis of the Ulna Combined with Radial Head Dislocation in a Child: A Case with 20 Years Follow-Up

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.

One-Bone Forearm Procedure for Acquired Pseudoarthrosis of the Ulna Combined with Radial Head Dislocation in a Child: A Case with 20 Years Follow-Up

This report describes a 6 year-old boy who was treated with one-bone forearm procedure for acquired pseudoarthrosis of the ulna combined with radial head dislocation after radical ulna debridement for osteomyelitis. At more than 20 years of follow-up, the patient had a nearly full range of elbow movements with a few additional surgical procedures. Pronation and supination was restricted by 45degrees, but the patient had near-normal elbow and hand functions without the restriction of any daily living activity. This case shows that one-bone forearm formation is a reasonable option for forearm stability in longstanding pseudoarthrosis of the ulna with radial head dislocation in a child.

Fungating primary locally malignant giant cell tumor of ulna: a case report.

A giant cell tumor with local aggressiveness and penetration of cartilage is quite rare. We present a case of fungating giant-cell tumor of lower end of the ulna with wrist involvement including penetration of cartilage and diaphysis. Involvement with all these characteristics, according to the literature reviewed, is the first case of its type. We are of the opinion that the fungation may be due to incision and drainage and delayed presentation at tertiary care centre.

[Intramuscular haemangioma of the forearm with radial and ulnar periosteal reaction [Report of one case]]

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain x-ray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen

[Epithelioid hemangioendothelioma of the wrist and the hand a case report]

The primitive epitheliod hemangio-endothelioma of bone is a rare vascular tumor recently described. A case of epitheliod hemangio-endothelioma of the distal phalanx and the ulna of the left band in a 15 years old young man is reported. In the same side soft tissue tumors of the hand and the forearm have been simultaneously diagnosed. In the same time radical excision with bone grafting was performed. The histologic and immunohistochemical study confirm the diagnosis. At the 8 years follow-up there was no clinical evidence of recurrence or metastasis. In the literature the outcome is not well defined. However no death was reported in the bone localization. Surgical resection with bone grafting to prevent pathologic fracture is suggested as a treatment, althongh it's not well codified in this rare lesion

Superalimentação e desenvolvimento do esqueleto de cães da raça Dogue Alemão: aspectos clínicos e radiográficos / Overfeeding and skeletal development in Great Dane puppies: clinical and radiographic aspects

Estudou-se o efeito da superalimentação no desenvolvimento do esqueleto de 14 cães da raça Dogue Alemão, utilizando dieta hipercalórica (ração super-premium) associada ao método de alimentação à vontade. Os animais foram distribuídos em dois tratamentos, sendo a ração fornecida à vontade ou restrita. O consumo de alimento foi registrado diariamente e realizaram-se, mensalmente, radiografias do cotovelo e, bimestralmente, do ombro, do quadril e do carpo, visando acompanhar alterações do esqueleto, especificamente quanto ao aparecimento da osteocondrose do ombro e da metáfise distal da ulna, da osteodistrofia hipertrófica e da displasia coxofemoral (DCF). Ao final do experimento, seis cães do grupo que recebeu alimentação à vontade apresentaram-se gordos (87,7 por cento) e um animal obeso (14,3 por cento). Do grupo de alimentação restrita, três filhotes mostraram condição corporal ideal (42,8 por cento), e quatro apresentaram-se magros (57,2 por cento). O exame radiológico revelou alterações compatíveis com o diagnóstico de DCF nos dois grupos; nos alimentados à vontade, a prevalência foi de 51,1 por cento e nos restritos, de 28,6 por cento. A osteocondrose na metáfise distal da ulna, conhecida como retenção do núcleo cartilaginoso, foi observada apenas nos cães alimentados à vontade (57,1 por cento). A superalimentação provocada pelo método de alimentação à vontade, associada com dieta de alta palatabilidade e alta densidade energética em filhotes da raça Dogue Alemão, induziu ao aparecimento de osteocondrose na metáfise distal da ulna e de displasia coxofemoral.

The effects of overfeeding on growing Great Dane puppies were examined by ad libitum feeding of a hypercaloric diet (super premium ration). Fourteen puppies from six litters were divided into two groups, with representation from each litter in each group. The dogs in the overfed group were provided ad libitum access to the diet from 8 AM to 6 PM daily, while the restricted group received the same feed but in amounts recommended by the manufacturer at 7 AM, 12:30 PM and 5 PM. Daily intake was individually recorded. To monitor skeletal changes due to osteochondrosis, hypertrophic osteodystrophy and hip dysplasia, elbow radiographs were taken monthly and shoulder, pelvis and corpus radiographs were taken bi-monthly. Weekly feed consumption and weight gain were greater in ad libitum than in restricted puppies (P<0.01). At the end of the experiment, 85.7 percent of the ad libitum group was over weight and 14.3 percent was obese, whereas 57.2 percent of restricted puppies were slim and 42.8 percent had ideal body weight. None of the dogs had hypertrophic osteodystrophy. Radiographic examination showed alterations compatible with hip dysplasia in both groups, but such observations were more frequent and more severe in the ad libitum group. Osteochondrosis of metaphisis distal ulna, known by the retention of cartiloginous nucleus, was observed only in the ad libitum group, at a rate of 57.1 percent. The thickness of the cortical and diameter of the ulna were greater (P<0.01) in ad libitum dogs than in those fed a restricted amount of the same diet. In summary, overfeeding caused by ad libitum access to a highly palatable and high energy food caused osteochondrosis and hip dysplasia in Great Dane puppies.

Hemophilic pseudotumor of the ulna treated with low dose radiation therapy: a case report

We report a case of hemophilic pseudotumor in the ulna of a 6-year-old boy treated with radiation therapy. A total dose of 900 cGy in 6 fractions was given in 6 consecutive days. Progression of cystic changes was halted within a month. New bone formation and trabeculation were found on the 4th month. Complete healing of the lesion and bony replacement were found on the 12th month. The patient was followed up to 72 months and there was no evidence of recurrence and no bone growth disturbance. Radiation therapy can be an effective alternative modality in treating hemophilic pseudotumor.

Effect of size and shape of the allogeneic bone grafts in bridging experimental ulnar gap in rabbits.

Partially decalcified allogeneic bone matrix was cut into the sizes and shapes of cylinders, bone strips and pulverized bone powder. Large osteoperiosteal gaps were created in rabbit's ulnae. A total of 14 gaps were filled with bone strips, 20 with powder, six with cylinders and two were left unbridged to serve as control. The healing of gap was assessed at intervals with a maximum follow up of 24 weeks. Clinically at 12 weeks the bone strips could not be moved separately from each other, the whole tubular bone had also united whereas gaps filled with bone powder did not diminish in size. Radiologically union occurred earlier (around 12 weeks) in bone strips as compared to cylinders (approx-18 weeks). With bone powder only a faint line of the remnants was visible. Gross examination findings of the grafted area were in concurrence with the clinical and radiological findings. Overall the gaps filled with bone strips had 100 per cent success with early osteo induction and remodelling as compared to long cylinders whereas gaps filled with bone powder had complete failure.

Açäo da calcitonina na resoluçäo de perfuraçöes ósseas em coelhos: controle fotodensitométrio e histológico / Effects of calcitomin in resolution of bone perforations in rabbits: photodensitometric and histogic control

Os autores estudam os efeitos da calcitonina humana sintética (CHS) em perfuraçöes ósseas de ulnas de 13 coelhos, agrupados em uma amostra controle e um grupo tratado com CHS, na dose de 0,34UI (0,34mg) em duas administraçöes diárias por via IM durante 15 dias. Como parâmetros evolutivos utilizaram-se a microfotodensitometria, método destinado a avaliar a densidade óssea das áreas perfuradas, e também a verificaçäo das condiçöes histopatológicas locais após 15 dias de reparaçäo óssea. Os resultados obtidos ressentem-se do pequeno número da amostra; contudo, permitem supor que, através de mecanismos näo inteiramente confirmados, a calcitonina parece ter interferido positivamente na reparaçäo das perfuraçöes ósseas

Angiomatosis con osteolisis (Síndrome de Gorham) / Angiomatosis with osteolysis (Gorham syndrome)

El síndrome de Gorham se caracteriza por presentar nevos angiomatosos con disolución del hueso subyacente, produciendo la desaparición de la estructura ósea. Generalmente afecta a jóvenes en forma unilateral, comprometiendo cintura pelviana y escapular, y más raramente columna cervical y parrilla costal. La histología muestra linfangiomas disecantes o bien receptores estrogénicos. La evolución es en general mala, y en pocos casos autorresolutiva. Con respecto al tratamiento, los corticoides y citostáticos han dado poco resultado. Se puede intentar cirugía, hasta la amputación. Si bien este cuadro no reviste caracteres de malignidad, debido a su carácter agresivo debe ser diagnosticado y tratado correctamente. Se presentan dos pacientes: uno poseedor de un angioma y cuyo motivo de consulta fueron los dolores osteócopos; el otro, portador de una linfangioma que estaba diagnosticado como metástasis