[Interposition arthroplasty as treatment of osteochondritis of the second metatarsal head. A case report]. / Plastía de interposición en el tratamiento de osteocondritis del segundo metatarsiano. Presentación de un caso.

INTRODUCTION: Freiberg described this pathology in 1914, it is a relatively rare condition, it mainly affects the head of the second metatarsal. Treatment includes reduction of daily activity and use of orthoses. For surgical treatment numerous techniques exist such as: debridement, osteotomies, resection of the metatarsal head or the base of the phalanx, arthroscopic treatment, and arthroplasty. OBJECTIVE: To present the case of a 31 year old female, Stage V according to the Smillie classification and to describe the surgical technique of the interposition arthroplasty that was made. SURGICAL TECHNIQUE: Longitudinal incision of 2.5 cm in dorsal surface of metatarsophalangeal joint, identification of extensor tendon. Capsular incision, debridement and excision of osteophytes and regularization of the metatarsal head. The sinovial capsule is dissected and covered with the metatarsal head, finally sutured to the capsule in the plantar region. RESULTS: The patient has 2 years from surgery and is asymptomatic with 350 of flexion and 500 of extension. On simple X-rays an adequate metatarsophalangeal space can be observed. We consider that the procedure is one more alternative for the treatment of this condition.

[Treatment of tibial non-union with a large bone defect with half-tubular fibular graft, centromedullary nailing and bone graft]. / Tratamiento de la no unión tibial con gran defecto oseo con peroné en media caña, clavo centromedular e injerto oseo.

INTRODUCTION: Non-union is most frequent in the tibia. It may occur with bone loss and is most often seen in the mid-third, mainly as a result of high-energy trauma. Our purpose is to present a treatment alternative. MATERIAL AND METHODS: Prospective, longitudinal, experimental trial conducted between 1999 and 2004. Five patients classified according to Judet and Paley were included. A half-tubular fibular graft plus an autologous and/or heterologous iliac crest graft were used with a UTN nail for stabilization purposes; mean follow-up was 24 months. RESULTS: All patients were male. High energy trauma was the cause in 100%; 5 were Gustilo III fractures; Paley B1 type was present in 60%; the mean bone defect was 7.8 cm. Grade III Montoya bone healing was observed on average at 13.6 months. There were two complications; one infection that required removal of the synthesis without disrupting the healing, and one re-fracture which was managed at a different service. CONCLUSIONS: An autologous half-tubular fibular graft, plus autologous and/or heterologous graft, stabilized with a UTN nail, restores the loss caused by the bone defect and allows achieving an appropriate bone healing.

Tratamiento de las rupturas antiguas del tendón de Aquiles con plastía de fascia de gemelos / Treatment for ancient ruptures of the heel cord by gastrocnemius fascia plasty

Objetivo. Se pretende la reconstrucción de aquel 20 a 30 por ciento de las rupturas aquileas que subsisten sin reparación. Material y métodos. Se trata de 19 casos, 13 varones y 6 mujeres, con edad promedio de 34.6 años, que tuvieron ruptura inveterada del tendón de Aquiles, espontánea en 13, por herida en tres y como re-ruptura postoperatoria en otros tres. La evolución promedio era de tres meses (33 a 202 días). En la cirugía, se regularizaron los extremos, sin resecar más de 2 mm de los extremos y preservando el tejido fibroso. Con el tobillo en equino, se suturo la ruptura término-terminal tipo Bunnell con nylon-00, reforzando con un colgado sural de 8-10 cm de largo y 1.5-2 cm de ancho, rotado y suturado con nylon-00 a todo lo largo sobre la reconstrucción. Se utiliza un yeso largo en equino por tres semanas y luego otro corto sin suela por otras tres. Se inicia rehabilitación, pero la marcha en equino se indica hasta los seis meses. Resultados. Fueron buenos en general, después de dos a 20 meses, con la salvedad de dos casos con ocho y 10 semanas. En todos se observó engrosamiento del tendón, hecho que se considera útil por incrementar su fuerza tensil. Como complicación sólo hubo un caso de dehiscencia superficial. Conclusión. Esta técnica se recomienda para las rupturas inveteradas del tendón de Aquiles, debiendo en todo caso respetar el término apropiado para su completa recuperación antes de forzar la rehabilitación.