Hamate fractures.

OBJECTIVE: The purpose of this paper is to present our experience in the treatment of the fractures of the hamate and to make a review of the literature on this topic. MATERIAL AND METHOD: We retrospectively reviewed 10 patients treated in our clinic between 2005-2012 suffering from fractures of the hamate. Six cases were fractures of the body and four were fractures of the hamate. Five cases were of associated injuries. Diagnostic delay ranged from 30 days to 2 years. Patient follow-up ranged from 1 to 10 years. Patient satisfaction was evaluated using the DASH questionnaire. Five patients with a fracture of the body underwent surgery, and one was treated conservatively. Two patients with fracture of the hook of the hamate were treated with immobilization, and two more patients had the fragment removed. RESULTS: The grip strength and the digital clip were reduced in 2 cases. Flexion and extension of the wrist was limited in 3 cases. The mobility of the fingers was normal in all the cases, except in one. The results obtained from the DASH questionnaire were normal in all the cases, except in one case of fracture of the hamate, and in two cases of fracture of the body. CONCLUSIONS: The surgical treatment should reduce the dislocation and stabilize the injuries with osteosynthesis. The fractures of the hamate are usually diagnosed late, and the most recommended treatment is removal of the fragment, although it cannot be deduced from this study.

[Preiser's disease. A case study]. / Enfermedad de Preiser. A propósito de un caso.

The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist.

Enfermedad de Preiser. A propósito de un caso / Preiser's disease. A case study

La necrosis avascular idiopática del escafoides o enfermedad de Preiser es una entidad de la que se han descrito pocos casos. En algunas ocasiones es discutible si se trata de una osteonecrosis espontánea o representa un proceso patológico secundario a enfermedades sistémicas, tratamiento quimioterápico o está relacionada con el consumo de esteroides. Presentamos el caso de una mujer de 20 años de edad, sin traumatismo previo, con dolor en la muñeca derecha de 4 años de evolución. Había sido erróneamente diagnosticada de una tendinitis y tratada de forma conservadora sin mejoría. Se solicitaron estudios de imagen mediante radiología simple. Los hallazgos radiológicos presentaban una anomalía del polo proximal del escafoides que originaba una fragmentación del mismo, hecho que se confirmó posteriormente con la realización de una TC. A continuación se realizó una RMN en la que se observaron criterios de isquemia, fundamentalmente en polo proximal. En la RMN con contraste paramagnético aparecieron signos de viabilidad en el fragmento distal y de osteonecrosis en el proximal. Tras las pruebas de imagen se diagnosticó de necrosis avascular idiopática del escafoides. El tratamiento quirúrgico consistió en extirpar los fragmentos necróticos del polo proximal y practicar una neurectomía del nervio interóseo posterior. A los 2 años de la intervención, la paciente se encuentra asintomática y con un balance articular completo de la muñeca intervenida (AU)

The idiopathic avascular necrosis of the scaphoid or Preiser's disease is condition about which few cases have been described. In the majority of cases, it is debatable whether it is actually a spontaneous osteonecrosis, or a pathological process secondary to a systematic disease, or a result of chemotherapy treatment, or associated with taking steroids. We present the case of a 20-year old woman, with no previous trauma, with pain in her right wrist, which progressed over a period of four years. It was wrongly diagnosed as a tendinitis, and was treated conservatively without any improvement. A simple X-ray was requested that showed an abnormality of the proximal pole of the scaphoid that was beginning to fragment; a fact which was confirmed later by performing a CT scan. This was followed by nuclear magnetic resonance spectroscopy (NMR), which showed signs of ischaemia, mainly in the proximal pole. There were signs of viability in the distal fragment in the NMR using paramagnetic contrast. After the imaging tests, idiopathic avascular necrosis of the scaphoid was diagnosed. The surgical treatment consisted of the removal of necrotic fragments of the proximal pole and removal of the posterior interosseous-nerve. Two years after the intervention, the patient is asymptomatic and with a complete range of movement in the operated wrist (AU)

Tratamiento del osteoma osteoide mediante radiofrecuencia guiada por tomografía computarizada / Treatment of osteoid osteoma by means of CT-guided radiofrequency

Objetivos: Presentar los resultados obtenidos en el tratamiento del osteoma osteoide mediante resección percutánea con radiofrecuencia guiada por tomografía computarizada (TC), exponer la técnica utilizada y mostrar las ventajas económicas del procedimiento, comparado con la técnica quirúrgica tradicional. Pacientes y metodología: Se estudiaron 21 pacientes que presentaban un osteoma osteoide localizado en el fémur (11 casos), la tibia (7 casos), la pelvis (un caso), el astrágalo (un caso) y la mano (un caso), entre octubre de 2001 y julio de 2007. Se introdujo un electrodo de punta fría guiado por TC en el centro del nidus y se conectó a un generador de radiofrecuencia. Los pacientes permanecieron ingresados 10h y volvieron a su actividad habitual de forma inmediata. Se realizó un estudio económico comparativo con la técnica convencional que elimina el fragmento óseo que contiene el tumor a cielo abierto y la descrita en este trabajo. Resultados: Los resultados obtenidos muestran la desaparición completa de la sintomatología en 20 casos y el caso restante mejoró al repetir el procedimiento. El estudio económico revela un ahorro de costes hospitalarios para el procedimiento realizado con radiofrecuencia. Conclusiones: Es una técnica fácil, percutánea y ambulatoria. Está indicada en casi todas las localizaciones. No se han descrito complicaciones importantes y proporciona buenos resultados (AU)

Purpose: To present the results obtained in the treatment of osteoid osteoma by percutaneous resection using computerized tomography-guided radiofrequency. We discuss the technique used and report on the economic advantages of the procedure, as compared with the traditional surgical technique. Patients and methodology: Between October 2001 and July 2007, twenty-one patients were analyzed who presented with an osteoid osteoma located in the femur (11 cases), tibia (7 cases), pelvis (1 case), talus (1 case) and hand (1 case). A CT-guided cool-tip electrode was introduced into the center of the nidus, connecting it to a radiofrequency generator. Patients stayed in hospital for 10h and immediately afterwards returned to their usual activities. A study was carried out to compare the cost/effectiveness of the CT-guided RF technique as compared with the conventional technique, whereby open surgery is performed to remove the bone fragment contained by the tumor. Results: The results obtained show complete remission of symptoms in 20 cases; the remaining case improved when the procedure was repeated. The cost/effectiveness study revealed hospital cost savings for the RF procedure. Conclusions: This is a simple percutaneous technique that can be carried out on an outpatient basis. It is indicated in nearly all locations. No significant complications have been reported and the results obtained have been satisfactory (AU)

Osteotomía tibial de valguización con cuñas de fosfato tricálcico / Opening-wedge valgus high tibial osteotomy with tricalcium phosphate

Objetivo. Valorar una variante en las osteotomías valguizantes de adición interna, consistente en la colocación de cuñas de fosfato tricálcico sintético reabsorbible. Material y método. Entre septiembre de 1996 y marzo de 2003 fueron intervenidos 42 pacientes en los que se efectuaron 43 osteotomías de valguización implantando cuñas de fosfato tricálcico. La artrosis primaria fue la causa etiológica predominante (41 casos), 2 casos correspondían al Grado I de Ahlbäck, 28 casos al Grado II y 11 casos al Grado III. Resultados. El dolor preoperatorio fue de 19,88 ± 5,39 puntos y en la revisión actual 27,20 ± 5,37 puntos (p < 0,00005); la capacidad de marcha en el preoperatorio fue de 17,30 ± 1,50 puntos y 19,53 ± 2,55 puntos en la actualidad (p < 0,00005), la flexión media del preoperatorio fue de 128,8° ± 6,2° y 132,3° ± 4,2° en la última revisión (p < 0,00005). En todos los casos se observó la consolidación radiológica. La medición del ángulo fémoro tibial medio obtenido en el preoperatorio fue de 184,7° ± 2,6° y en la revisión actual de 175,58° ± 2,07° (p < 0,00005). Conclusiones. La utilización de cuñas de fosfato tricálcico en las osteotomías de valguización ha demostrado unos resultados satisfactorios, consiguiéndose la consolidación radiológica en todas las osteotomías y no observándose complicaciones inherentes a la cuña de fosfato tricálcico

Purpose. To assess the effectiveness of a variety of high tibial osteotomy with internal fixation that consists in the placement of reabsorbable synthetic tricalcium phosphate wedges. Materials and methods. Between September 1996 and March 2003, 42 patients were subjected to 43 high tibial osteotomies with implantation of tricalcium phosphate wedges. Primary osteoarthritis was the predominant etiology (41 cases); 2 cases corresponded to Ahlbäck's Grade I, 28 cases were Grade II and 11 cases were Grade III. Results. Preoperative pain was 19.88 ± 5.39 points and currently 27.20 ± 5.37 points (p < 0.00005); preoperative walking capability was 17.30 ± 1.50 points and 19.53 ± 2.55 at present (p < 0.00005), pre-op mean flexion was 128.8° ± 6.2° and 132.3° ± 4.2° at the last examination (p < 0.00005). In all cases radiological incorporation was observed. The size of the mean tibiofemoral angle as measures preoperatively was 184.7° ± 2.6° and currently 175.58° ± 2.07° (p < 0.00005). Conclusions. The use of tricalcium phosphate wedges in high tibial osteotomies has shown satisfactory results. Radiological incorporation was achieved in all osteotomies performed; no complications were observed that could be attributable to the tricalcium phosphate wedges (AU)