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.

Trastornos temporomandibulares en la infancia: bruxismo de sueño y compromiso de atm en artritis idiopática juvenil / Temporomandibular disorders in childhood: sleep bruxism and temporomandibular joint involvement in juvenile idiopathic arthritis

Los trastornos temporomandibulares (TTM) corresponden a un grupo de condiciones musculoesqueletales y neruromusculares que involucran las articulaciones temporomandibulares (ATM), los músculos masticatorios y todos los tejidos asociados. La etiología de los TTM es considerada multifactorial, siendo el bruxismo de sueño (BS) uno de muchos factores asociados con TTM dolorosos. Tanto los TTM como el BS se presentan en adultos y niños y actualmente es sabido que la etiopatogenia de ambos no difiere de acuerdo a la edad. Las ATM son articulaciones sinoviales que pueden verse afectadas por diversos TTM o por condiciones sistémicas como la artritis idiopática juvenil (AIJ). La ATM está involucrada en un 40% de los pacientes con AIJ, siendo subestimada debido a que clínica-mente se manifiesta con poco dolor. En el presente artículo se revisarán los conceptos de TTM y BS en niños, así como también la manifestación de la AIJ en el territorio orofacial, entregando una aproximación de su etiopatogenia, identificación y manejo.

Temporomandibular disorders (TMD) encompass a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joints (TMJ), the masticatory muscles, and all associated tissues. TMD's etiology is considered to be mul-tifactorial, were sleep bruxism (SB) is one of many causes of painful TMD. TMD and SB can present in adults and children and the etiology does not differ regarding age.TMJ are synovial joints that can be affected by many TMD as well as systemic conditions such as juvenile idiopathic arthritis (JIA). TMJ are involved in 40% of patients with JIA, which is usually underestimated because of its painless presentation.This article will review the concepts of TMD and SB in children, as well as JIA presentation in the orofacial region.

Expression of Cdcrel-1 (Pnutl1), a gene frequently deleted in velo-cardio-facial syndrome/DiGeorge syndrome.

The murine Cdcrel-1 (Pnutl1) gene belongs to the family of septins, which are thought to be involved in cytokinesis in yeast, Drosophila and vertebrates. Recent studies implicate Cdcrel-1 in the regulation of vesicle transport in neurons of the adult brain. The human homologue, hCDCREL-1 maps to chromosome 22q11.2, a region commonly deleted in patients displaying velo-cardio-facial syndrome (VCFS) or DiGeorge syndrome (DGS). During development, Cdcrel-1 transcripts are expressed from E10.5 on in the nervous system such as the dorsal root ganglia and the cranial ganglia as well as the lateral layer of the neural tube, the area where terminally differentiated neurons are located. Low level expression is found in the mesenchyme of the frontonasal mass and the limb bud mesenchyme of E11.5 and E13.5 murine embryos. At E15.5, expression is detected in the nervous tissue and in the neural layer of the eye. Based on the expression pattern as well as clinical data, Cdcrel-1 may be involved in the etiology of VCFS/DGS.