Universal 2™ total wrist arthroplasty: A single-surgeon 6.5-year follow-up study of 22 prostheses.

Total wrist arthroplasty remains controversial, with the few studies undertaken being heterogeneous and having low patient numbers. This prospective study involved 22 Universal 2™ total wrist prostheses implanted by the same surgeon between 2003 and 2017. There were 13 women and nine men with an average age of 56 (42-69.5) years. Indications for total wrist arthroplasty were post-traumatic arthritis, rheumatoid arthritis and Kienböck's disease. The mean follow-up was 6.5 (3-17) years. Two failed implants required total wrist fusion. Postoperative pain, grip strength, QuickDASH, patient-rated wrist evaluation, and Mayo wrist scores improved significantly compared with preoperative scores. The prosthesis preserved equal or slightly greater range of motion than the preoperative range of motion, sufficient to undertake activities of daily living and improve quality of life. Postoperative radiographs 1 month after the surgery and then annually showed signs of bone deterioration in 64% of implants, most osteolysis without loosening, compatible with asymptomatic function. Although a high number of radiographic signs of implant changes were apparent in the midterm, 91% of prostheses are still in place. The long-term survival of this implant is uncertain. LEVEL OF EVIDENCE: Therapeutic IV.

Total distal radioulnar joint prosthesis as salvage surgery in multioperated patients.

The purpose of this study was to report the results following implantation of a total distal radioulnar joint prosthesis in five multioperated patients with posttraumatic or Essex-Lopresti injury. The range of motion (ROM) for flexion and extension, radial deviation and ulnar deviation of the wrist, and pronation and supination of the forearm, grip strength, pain intensity through a visual analog scale (VAS), surgical complications and ability to return to work, were recorded. Subjective and objective functions were assessed using the quick DASH questionnaire and the modified Mayo wrist score, respectively. The mean postoperative follow-up was 4.3 years. Average postoperative increase in ROM was 28.8° for flexion-extension; 2.2° for radial and ulnar deviation, and 18° for pronation-supination, reaching 85.8%, 85% and 80.8% of the contralateral hand function, respectively. Grip strength increased by 6.8kg, with recovery of 78% of the strength of the unaffected hand. VAS score decreased to a mean of 6.2 postoperatively. There were complications in two cases. All five patients showed no signs of implant loosening or movement. The quick DASH score decreased from a mean of 85 preoperatively to 38.6 postoperatively. The modified Mayo wrist score increased from a mean of 24 preoperatively to 73 at final follow-up. Four patients recovered their professional and daily activities without restriction and were satisfied with the procedure; one patient with heterotopic bone formation at the distal tip of the ulnar stem did not want any further surgery and agreed to job modifications.

Nerve compression syndromes of the hand and forearm associated with tumours of non-neural origin and tumour-like lesions.

Nerve compression syndromes caused by non-neural tumours or tumour-like lesions are rare. We retrospectively reviewed 541 consecutive patients operated on by the same surgeon to study nerve compression syndromes in the forearm and hand. There were 414 due to nerve compression and 127 caused by tumours. Twenty-two patients showed compression neuropathy associated with 17 tumours and six tumour-like lesions, with 13 different pathological types. The most common types were fatty and vascular tumours. Twenty-one tumours were extraneural and one was intraneural. The median nerve was affected in nine cases, the ulnar nerve or the dorsal sensory branch of the ulnar nerve in five cases, the posterior interosseous nerve or the superficial radial branch in four cases and the common digital nerves in two cases. There was a concomitant involvement of the median and ulnar nerves in two other patients. Clinically, there were eight different compression neuropathies, of which the most frequent was the carpal tunnel syndrome. The postoperative histology was consistent with preoperative magnetic resonance imaging findings in the vascular and fatty tumours. Pain disappeared completely in 15 out of 16 patients with preoperative pain. All patients had preoperative paraesthesia, which persisted after tumour excision in three patients: attenuated in two patients and unchanged in one. In three patients, we did not observe any change in paresis or amyotrophy. The mean postoperative follow-up was 31 months, without tumour recurrence. The quick Disabilities of the Arm, Shoulder and Hand (DASH) score went from 49.9 points preoperatively to 10.2 points after surgery.

Are tendon transfers justified in very old hand radial palsies?

There have been very few reports about results of tendon transfers carried out in very old radial palsies affecting the hand. We present two cases of radial palsy operated 52 and 30 years after the original injury, which also had after-effects in pronosupination due to elbow injuries. In the first patient, with high radial-nerve palsy, we made a triple transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi ulnaris to the extensor digitorum communis and the palmaris longus to the extensor pollicis longus. In the second case, which had posterior interosseous nerve palsy, we transferred the flexor carpi radialis to the extensor digitorum communis, and the brachiorradialis to the extensor pollicis longus. The surgical findings showed a 'gelatinous degeneration' in some of the receiving tendons, which did not prevent the sutures from being resistant. The first patient, who had a stiff elbow, with pronosupination blocked since childhood, showed disuse atrophy of the pronator teres, which conditioned a late rupture of the tenomuscular junction and required a second surgery for wrist arthrodesis. Results after postoperative period of 30 months after surgery in the first patient, and 14 months after surgery in the second one, showed functional recovery in finger range of extension, grip and key-pinch strength and a significantly higher QuickDASH score, restoring the natural aesthetical appearance of the limb. This facilitated the return to professional and daily activities, re-establishing a fine ability to grab and release objects.

Thumb metacarpophalangeal joint ligament reconstruction with a triangular tendon graft in posttraumatic chronic instability.

UNLABELLED: The purpose of this study was to report the results of static triangular ligament reconstruction, in thumb metacarpophalangeal (MCP) joint chronic posttraumatic laxity using a tendon graft with a proximal apex in ten patients. The mean postoperative follow-up was 40.2 months. The mean postoperative thumb MCP joint stress testing was 43° less than before surgery, and 6.5° less than in the non-injured hand. The mean range of flexion was 10.5° lower in the operated thumb than in the contralateral one, and the mean range of extension was 8° lower. Minimal differences in the values of the Kapandji score, grip and key-pinch strength were found. The preoperative pain became an occasional discomfort after surgery. All patients had a subjective sense of stability until final follow-up. All patients returned to their work or daily activities. LEVEL OF EVIDENCE IV: For therapeutic studies investigating the results of treatment.

Carpo giboso sintomático debido a hueso estiloideo: diagnóstico por imagen / No disponible

No disponible

Artroplastia de muñeca y mano / Arthroplasty of the wrist and hand

Las manos son el principal órgano para la manipulación física del medio y la principal fuente de información táctil sobre el entorno. La especialización de los hemisferios cerebrales ha determinado que en el ser humano se produzca la dominancia de una mano para actividades de destreza, habilidad y/o fuerza sobre la otra. La cirugía de la mano es una de las ramas de la cirugía que con mayor rapidez se ha desarrollado desde la Segunda Guerra Mundial, como tantos otros conocimientos médicos y quirúrgicos. La historia de las artroplastias está ligada al tratamiento del dolor y al intento de recuperar la funcionalidad de las articulaciones y, en el caso de las manos, a las graves deformaciones, secundarias a enfermedades inflamatorias crónicas invalidantes, como la artritis reumatoide (AR), o secuelas traumáticas. La indicación de artroplastia en la mano (interfalángica proximal, interfalángica distal, metacarpofalángica y trapecio-metacarpiana) y la muñeca entraña una gran complejidad, por la estrecha relación funcional existente entre las articulaciones. La función de una articulación depende de las demás, y por lo tanto cualquier procedimiento practicado en una articulación incide en la actividad de las otras, y además la delicadeza de los tejidos blandos (tendones, ligamentos, etc.) complica notablemente las probabilidades de una rehabilitación adecuada. La rehabilitación y los cuidados postoperatorios desempeñan un papel muy importante en el éxito de la artroplastia. El objetivo fundamental es conseguir una movilidad precoz protegida. En función de la articulación y del tipo de artroplastia practicada se indican distintos procedimientos terapéuticos

The hands are the main organ for physical manipulation of the setting and primary source of tactile information on the surroundings. The specialization of the cerebral hemisphere has determined that there is dominance of one hand for activities of skills, aptitudes and/or force over the other hand in the human being. Hand surgery is one of the branches of surgery with the fastest development since the Second World War, as other medical and surgical knowledge. The history of arthroplasties is linked to treatment of pain and attempt to recover functionality of the joints and in the case of the hands, to the serious deformations, secondary to chronic, invalidating inflammatory diseases such as rheumatoid arthritis or traumatic sequels. The indication of arthroplasty in the hand (IPJ, PIP, MCP, TMJ) and wrist, entails great complexity due to the close functional relationship existing between the joints. The function of a joint depends on the others and thus any procedure performed in a joint affects the activity of the others and also the delicacy of the soft tissues (tendons, ligaments, etc.) significantly complicates the likelihoods of adequate rehabilitation. Rehabilitation and post-operative cares play a very important role in the success of the arthroplasty. The fundamental purpose is to achieve early protected mobility. Based on the joint and type of arthroplasty performed, different therapeutic procedures are indicated (AU)

[An unusual manifestation of osteo-articular, tendinous and nervous involvement secondary to tophaceous gout of the hand. A report of two cases]. / Rare manifestation de lésion ostéoarticulaire, tendineuse et neurologique par goutte tophacée de la main. Deux cas cliniques.

Tophaceous gout of the hand is a rare condition, but possible in chronic cases. We report two cases (three hands) with a long history of hyperuricemia and serious lesions due to deposition of sodium urate crystals. In these cases we point out several fundamental aspects: the abnormal size of the tophi, the destruction of triquetum and pisiform, the digital joint instability due to ligamentous lesions, the tenosynovitis and digital flexion contracture secondary to intratendinous deposition of urates, and the presence of a double ipsilateral tunnel syndrome of the median and ulnar nerves at the wrist. After neurolysis and tophus resection, a rapid and very substantial relief of paraesthesiae was seen. Recovery of partial active wrist and finger movements required a variety of surgical interventions. The results are analysed after 2 years for the first case, and 8 months for the second.

Artroplastia de muñeca y mano / Arthroplasty of the wrist and hand

Las manos son el principal órgano para la manipulación física del medio y la principal fuente de información táctil sobre el entorno. La especialización de los hemisferios cerebrales ha determinado que en el ser humano se produzca la dominancia de una mano para actividades de destreza, habilidad y/o fuerza sobre la otra. La cirugía de la mano es una de las ramas de la cirugía que con mayor rapidez se ha desarrollado desde la Segunda Guerra Mundial, como tantos otros conocimientos médicos y quirúrgicos. La historia de las artroplastias está ligada al tratamiento del dolor y al intento de recuperar la funcionalidad de las articulaciones y, en el caso de las manos, a las graves de formaciones, secundarias a enfermedades inflamatorias crónicas invalidantes, como la artritis reumatoide (AR), o secuelas traumáticas. La indicación de artroplastia en la mano (interfalángica proximal, interfalángica distal, metacarpofalángica y trapecio metacarpiana) y la muñeca entraña una gran complejidad, por la estrecha relación funcional existente entre las articulaciones. La función de una articulación depende de las demás, y por lo tanto cualquier procedimiento practicado en una articulación incide en la actividad de las otras, y además la delicadeza de los tejidos blandos (tendones, ligamentos, etc.) complica notablemente las probabilidades de una rehabilitación adecuada. La rehabilitación y los cuidados postoperatorios desempeñan un papel muy importante en el éxito de la artroplastia. El objetivo fundamental es conseguir una movilidad precoz protegida. En función de la articulación y del tipo de artroplastia practicada se indican distintos procedimientos terapéuticos (AU)

The hands are the main organ for physicalmanipulation of the setting and primary source of tactile informationon the surroundings. The specialization of the cerebral hemisphere has determined that there is dominance of one hand for activities of skills, aptitudes and/or force over the other hand in the human being. Hand surgery is one of the branches of surgery with the fastest development since the Second World War, as other medical and surgical knowledge. The history of arthroplastiesis linked to treatment of pain and attempt to recover functionality of the joints and in the case of the hands, to the serious deformations, secondary to chronic, invalidating inflammatory diseases such as rheumatoid arthritis or traumatic sequels. The indication of arthroplasty in the hand (IPJ, PIP, MCP,TMJ) and wrist, entails great complexity due to the close functional relationship existing between the joints. The function of a joint depends on the others and thus any procedure performed in a joint affects the activity of the others and also the delicacy of the soft tissues (tendons, ligaments, etc.) significantly complicates the likelihoods of adequate rehabilitation. Rehabilitation and post-operative cares play a very important role in the success of the arthroplasty. The fundamental purpose is to achieve early protected mobility. Based on the joint and type of arthroplasty performed, different therapeutic procedures are indicated (AU)

Deforming chondrosarcoma of the fingers secondary to a long-term enchondromatosis of 28 years.

Enchondromatosis of the hand in the context of the Oilier disease is an infrequent pathologie associated with a high rate of malignancy. In this work, we present a case with multiple enchondromas affecting mainly the fourth and fifth rays of the hand, and with multiple ipsilateral lesions in the foot, sacroiliac joint and iliac bone. This patient is, in addition, an unusual case for a long-term progression (28 years), serious deforming appearance and for the double malignant degeneration to chondrosarcoma of the affected fingers. Clinical features, tumor factors, criterion of diagnosis and prognosis, surgical strategy and follow-up evaluation are analysed, as well as a review of the literature.

The multiple monoblock toe-to-hand transfer in digital reconstruction. a report of ten cases.

Ten hands with multiple traumatic finger amputations or congenital agenesis underwent reconstruction by monoblock transfer of multiple toes. Eight patients underwent monoblock transfer of the great and second toes, one patient received the great toe and the metatarsophalangeal joint from the second toe with the same vascular pedicle, and another patient the great, second and third toes as a block. Only part of the great toe was ever taken, while the second toe was totally or partially taken. The surgical technique and the outcome are detailed in this work, with a mean postoperative follow-up of 6 years.

[Frostbite of the upper and lower limbs in an expert mountain climber: the value of bone scan in the prediction of amputation level]. / Congelaciones de manos y pies en un montañero de elite: utilidad de la gammagrafía ósea para predecir el nivel de amputación.

A 38 year old man was admitted to our hospital 10 days after suffering a frostbite injury in hands and feet while practicing mountain climbing, at 8,100 meters of altitude, while he was trying to reach the top of the K2 mountain. A 99mTc-MDP bone scan performed in aseptic conditions showed: in hands: absence of bone uptake in the 3rd phalanx and distal portion of 2nd phalanx of the 5th finger of the left hand, and multiple areas of increased uptake in the distal portion of both hands. In feet: uptake decreases in the 2nd phalanx of the first toe of the left foot, and absence of bone uptake in the 3rd phalanx of the 2nd toe of the left foot, and in 2nd phalanx of the 1st toe and 3rd phalanx of the 2nd, 3rd and 4th toes of the right foot. As in the hands, there were multiple areas of increased uptake in the distal portion of both feet. The phalanges with absence of bone uptake had to be amputated, while those that presented increased uptake recovered with conservative treatment. Bone scan is indicated in the evaluation of frostbite injuries and helps to establish the prognosis early.

Congelaciones de manos y pies en un montañero de elite: utilidad de la gammagrafía ósea para predecir el nivel de amputación / Frostbite of the upper and lower limbs in an expert mountain climber: the value of bone scan in the prediction of amputation level

Paciente de 38 años de edad que ingresa a los 10 días de sufrir un accidente por congelación en manos y pies durante la práctica del alpinismo, a unos 8.100 metros de altitud, mientras intentaba alcanzar la cima del K2. Se practica una gammagrafía ósea con 99mTc-MDP en condiciones de asepsia que muestra: En manos: defecto de captación en F3 y porción distal de F2 del 5º dedo de la mano izquierda. Incrementos de captación en la mayoría de dedos de ambas manos, de predominio distal. En pies: hipocaptación en F2 del primer dedo del pie izquierdo y defectos de captación en F3 del 2º dedo del pie izquierdo y en F2 del 1.er dedo y F3 del 2º, 3º y 4º dedos del pie derecho. Como en las manos, existen múltiples incrementos de captación de predominio distal. Las falanges de los dedos con defectos de captación tuvieron que ser amputadas, mientras que aquellas que presentaron incremento de captación curaron con tratamiento conservador. La gammagrafía ósea está indicada en las lesiones por congelación y ayuda a establecer el pronóstico precozmente. (AU)

Effects of haemodilution and rewarming with regard to digital amputation in frostbite injury: an experimental study in the rabbit.

Peripheral vascular failure with haematological and haemodynamic changes occurs after frostbite injuries. In order to study the effects of normovolemic haemodilution on the extent of digital necrosis, the paws of rabbits were haemodiluted and frozen to -15 degrees C. Dextran or gelatin was used as the plasma substitute in two groups and the rewarming after the cold injury was performed either at room temperature (22 degrees C) or with hot water baths (38 degrees C). The extent of necrosis was significantly less in the rabbits haemodiluted with dextran or gelatin and rewarmed in hot water baths.

The arterial system of the first intermetatarsal space and its influence in toe-to-hand transfer: a report of 53 long-pedicle transfers.

A study of the arterial system in the first intermetatarsal space was performed during 53 toe-to-hand or vascularized tissue of the toe transfers with long arterial pedicles. The first dorsal metatarsal artery was used as a single pedicle in 25 transfers and the first plantar metatarsal artery in 21: both arteries were taken simultaneously in seven transfers. In 11 transfers, the dorsalis pedis artery and the perforating branch were absent, although this did not exclude the presence of a first dorsal metatarsal artery which arose from the plantar system by means of an ascending vascular branch in seven cases.