Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis / Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

[Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término / Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. / [Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

[What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series]. / ¿Qué sabemos de las fracturas atípicas en los pacientes en tratamiento con bifosfonatos? Revisión bibliográfica a raíz de una serie de casos.

AIM: Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. MATERIAL AND METHODS: A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. RESULTS: Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. DISCUSSION: It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. CONCLUSIONS: Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years.

¿Qué sabemos de las fracturas atípicas en los pacientes en tratamiento con bifosfonatos? Revisión bibliográfica a raíz de una serie de casos / What do we know about atypical fractures in patients on biphosphonates treatment? A literature review using a case series

Objetivos. Realizamos una revisión retrospectiva de los pacientes en tratamiento de forma prolongada con bifosfonatos que presentaron fracturas subtrocantéreas y diafisarias de fémur de patrón atípico. Revisión de la literatura existente con el fin de realizar una actualización del tema con consideraciones de interés para el cirujano ortopeda y traumatólogo. Material y métodos. Revisión de 13 pacientes en tratamiento con bifosfonatos con fracturas subtrocantéreas y diafisarias de fémur tratadas en nuestro centro entre septiembre de 2007 y marzo de 2011. Resultados. Se detectaron 4 casos de fracturas subtrocantéreas y 13 de fracturas diafisarias. Cuatro pacientes presentaron fracturas bilaterales. Todas las fracturas eran completas salvo un caso en el que era incompleta con afectación de la cortical lateral. La intervención quirúrgica fue más demandante técnicamente por encontrarse un hueso pétreo como consecuencia de la medicación con bifosfonatos. Discusión. Existe la dificultad de establecer la relación causal directa entre el tratamiento prolongado con bifosfonatos y las fracturas atípicas femorales. No obstante, la literatura actual refiere un beneficio superior en la prevención de fracturas vertebrales y no vertebrales y, por tanto, se continua considerando a los bifosfonatos como un fármaco de primera elección en la prevención de las fracturas osteoporóticas. Conclusiones. Los pacientes con tratamiento prolongado con bifosfonatos pueden presentar fracturas atípicas femorales como complicación. Se considera que debe evaluarse en un periodo medio menor a 5 años la sustitución parcial o definitiva por otro fármaco, teniendo en cuenta el riesgo residual de fractura estimado en ese momento (AU)

Aim. Retrospective review of long term biphosphonates treated patients who sustained a subtrochanteric or diaphyseal femoral fracture with an atypical pattern. A literature review is presented as an update of the topic. Material and methods. A retrospective study was conducted on 13 subtrochanteric or diaphyseal fractures in female patients treated with biphosphonates at our institution from September 2007 to March 2011. Results. Four cases of subtrochanteric fractures and 13 diaphyseal fractures were detected. Four patients had bilateral fractures. All cases but one (that affected only the lateral cortex) were complete fractures. Surgically, these kinds of fractures are demanding due to the hardness of the bones. Discussion. It is difficult to know if there is any relationship between bisphosphonates treatment and atypical femoral fractures. Nevertheless, current literature supports a greater benefit of their use in preventing vertebral and non-vertebral fractures. For this reason, biphosphonates continue being considered as a first choice in the prevention of osteoporotic fractures. Conclusions. Patients on long-term treatment with bisphosphonates may present atypical femoral fractures as a complication. It is considered that the maximum period for biphosphonates treatment should not exceed 5 years (AU)