A technique for arthroscopic all-inside suturing in the wrist.

A technique for arthroscopic all-inside suturing in the wrist is presented. The procedure allows placement of the knot inside the joint without additional incisions. We have applied it in cases of dorsal, foveal and coronal tears of the triangular fibrocartilage. No special instrument is required apart from a Tuohy needle.

Sagittal rotational malunions of the distal radius: the role of pure derotational osteotomy.

Sagittal rotational malunion after distal radius fractures was identified in eight patients by the presence of a "hinge" point on the volar cortex on the lateral radiograph, and the ulnar head being shorter than the anterior lip of the radius on the posterior-anterior radiograph. The surgical correction consisted of preplating the distal fragment with a volar locking plate before an osteotomy through the "hinge" point, and correcting the dorsal tilt of the distal fragment. Any dorsal defect was filled with cancellous bone graft from the olecranon. Pain, range of motion and grip all improved. Disabilities of arm, shoulder and hand score changed from 54 to six. Dorsal sagittal tilt improved by 26 degrees , from -23 degrees to +3 degrees . Ulnar variance improved by 3 mm, from +1.5 to -1.5 mm, becoming identical to the opposite side. A pure derotational osteotomy corrected the apparent shortening of the radius and restored the volar tilt.

Colgajo microvascular corticoperióstico de cóndilo femoral para las pseudoartrosis diafisarias recalcitrantes de extremidad superior / Microvascular corticoperiosteal flap of the femoral condyle in the treatment of recalcitrant shaft nonunions in the upper limb

Objetivo. Presentar nuestra experiencia en el tratamiento de pseudoartrosis recalcitrantes en la extremidad superior mediante colgajos corticoperiósticos microquirúrgicos. Material y método. Cinco adultos (18-54 años), intervenidos antes de su traslado a nuestro centro en varias ocasiones (entre 3 y 7 veces), fueron tratados de pseudoartrosis diafisarias de la extremidad superior (dos húmeros, dos cúbitos y un radio). Tras el desbridamiento radical y osteosíntesis, el defecto óseo se rellenó con injerto de esponjosa y un colgajo corticoperióstico del cóndilo femoral, anastomosado a los vasos locales. Todos los casos comenzaron la movilización inmediata sin protección. Resultados. La supervivencia de los colgajos fue del 100%, sin complicaciones postoperatorias. Se consiguió la consolidación radiológica en menos de tres meses en todos los casos. Tres pacientes recuperaron el rango completo de movilidad articular y dos el rango de movilidad funcional. Conclusión. Los colgajos corticoperiósticos pueden ayudar a solventar pseudoartrosis recalcitrantes en la extremidad superior, incluso en casos de antecedentes de infección. Puede ser apreciado un evidente puente óseo en las radiografías 2 meses después del procedimiento

Materials and methods. Five adults (18-54 years of age), operated before referral to our centre on different occasions (3-7 times), were treated for upper limb shaft nonunion (2 humerus, 2 ulnas and 1 radius). After radical debridement and osteosynthesis, the bone defect was filled with cancellous bone graft and a corticoperiosteal flap from the femoral condyle, with anastomosis of local blood vessels. In all cases immediate mobilization was initiated without protection. Results. Flap survival was 100%, there were no postoperative complications. Healing determined by X-rays was seen in less than 3 months in all cases. Three patients recovered complete joint functional range of motion (ROM). Conclusion. Corticoperiosteal flaps can help to resolve recalcitrant nonunions in the upper limb, even in cases that have suffered infection. An obvious bone bridge can be seen in X-rays 2 months after the procedure

Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb.

The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.

Massive hand crush: the role of a free muscle flap to obliterate the dead space and to clear deep infection.

Death of tissue and/or deep infection leading to amputation is not an uncommon course of events after massive crush injuries of the central part of the hand. Management of this injury faces the dual problem of having to carry out debridement in the central part of the hand which is radical enough to remove all dead tissue but which, in itself, creates a huge dead space in the depths of the wound. Inadequate debridement and/or leaving a dead space which fills with fluid and detritus behind the flexor tendons leads on to infection, devascularisation of the fingers and amputation. This paper presents the results of very radical debridement of the hand dorsal to the flexor tendons, including the intermetacarpal spaces, and filling the dead space with a well-vascularised free muscle flap in two hands which were referred in a pre-amputation stage, with one already being infected. Both hands were salvaged.

Optimización del Colgajo de Gracilis Libre / Experience with the Gracilis Muscle Free Flap

El colgajo de músculo gracilis tiene una anatomía constante, es fácil de disecar y deja una mínima secuela. A pesar de estas ventajas no es un músculo popular. Entre los inconvenientes que se le achacan están: su corto pedículo vásculo-nervioso, el pequeño calibre arterial y la dificultad para adaptarlo al defecto por su forma de huso. Nuestro objetivo es presentar soluciones para estos problemas, basándonos en una experiencia de 18 casos para cobertura de extremidades y para rehabilitación dinámica. En nuestra práctica el colgajo de gracilis es de primera elección para defectos pequeños y medianos en los que se necesite un músculo. Desbanca a otros como el recto abdominal o e1 serrato por ser menor su secuela funcional y estética (AU)

Bacteriology in burn patients undergoing mechanical ventilation.

In this paper the authors introduce a retrospective study of the incidence of infectious processes in the Burns Unit of the Cruces Hospital (Bilbao), in those patients treated between 1995 and 1998, and who needed, for different reasons, mechanical ventilatory support. The most common microorganisms found in wound cultures, plugged telescoping catheter and blood cultures and analyse variations throughout the stay in the Burns Unit are described.