Clinodactilia postraumática del meñique en el pelotari manista / Post-traumatic clinodactyly of the little finger in Basque hand-pelota players

OBJETIVO: Cuantificar la desviación angular de la articulación interfalángica distal (IFD) del 5.° dedo y la presencia de cambios degenerativos en IFD en jugadores de pelota y compararlos con una población española. MATERIAL Y MÉTODOS: Estudio de casos y controles de una población de 40 pelotaris manomanistas federados y de un grupo control formado por 20 varones no practicantes de pelota. Se calcularon el ángulo IFD y la presencia de cambios degenerativos en la articulación. RESULTADOS: El ángulo IFD medio del 5.° dedo en el grupo control fue de 2,6° en la mano dominante y de 2,9° en mano no dominante. Grupo de pelotaris: ángulo IFD de 6,8° en mano dominante y 10,9° en la no dominante. El ángulo IFD fue significativamente mayor en la mano no dominante (p = 0,002) en el grupo de pelotaris. No se encontraron diferencias significativas entre ambas manos en el grupo control (p = 0,572). Se hallaron diferencias estadísticamente significativas tanto para la mano dominante (p = 0,001) como para la no dominante (p = 0,001) al comparar grupo control con pelotaris. Los pelotaris tienen un ángulo IFD superior a los controles en ambas manos. No se encontraron diferencias estadísticamente significativas en grupo pelotari según la posición en la cancha (p = 0,742 delantero, p = 0,747 zaguero) ni por categorías (p = 0,345 aficionado, p = 0,346 profesional). DISCUSIÓN: La práctica de pelota a mano se asocia a la presencia de una clinodactilia postraumática de la falange distal del 5.° dedo. La mano no dominante presenta unos ángulos mayores en IFD. La presencia de clinodactilia no genera limitación funcional

OBJECTIVE: The aim of this study is to measure the DIP joint angle of the little finger and presence of degenerative changes in the DIP joint in Basque hand-pelota players and compare it with the general Spanish population. MATERIAL AND METHODS: Cross-sectional study. We studied both hands of 40 male Basque pelota players (pelotaris) and 20 male controls. The assessment protocol consisted of a questionnaire, physical examination and bilateral plain radiographs. Distal interphalangeal (DIP) joint angle was measured on plain radiographs in both hands. RESULTS: The average DIP joint angle of the little finger in the control group was 2.6° in the dominant hand and 2.9° in the other hand. In the pelota players group we obtained a DIP angle of 6.8° in the dominant hand and 10.9° in the non-dominant hand. The DIP angle was significantly higher in the non-dominant hand (P=.002) in the pelota player group. Non-significant differences were obtained between both hands in the control group (p=.572). Significant differences were obtained in both player and control groups in the dominant hand (P=.001) and in the non-dominant hand (P=.001). Pelota players have a higher DIP angle in the little fingers than the control group. No differences were found in the pelota player group according to their position on the court (P=.742 forward, P=.747 defender) or sport level (P=.345 amateur, P=.346 professional). DISCUSSION: Basque hand-pelota produces post-traumatic acquired clinodactyly of the little finger. The non-dominant hand has a higher DIP joint angle. Clinodactyly poses no functional problems

Post-Traumatic Clinodactyly of the Little Finger in Basque Hand-Pelota Players. / Clinodactilia postraumática del meñique en el pelotari manista.

OBJECTIVE: The aim of this study is to measure the DIP joint angle of the little finger and presence of degenerative changes in the DIP joint in Basque hand-pelota players and compare it with the general Spanish population. MATERIAL AND METHODS: Cross-sectional study. We studied both hands of 40 male Basque pelota players (pelotaris) and 20 male controls. The assessment protocol consisted of a questionnaire, physical examination and bilateral plain radiographs. Distal interphalangeal (DIP) joint angle was measured on plain radiographs in both hands. RESULTS: The average DIP joint angle of the little finger in the control group was 2.6° in the dominant hand and 2.9° in the other hand. In the pelota players group we obtained a DIP angle of 6.8° in the dominant hand and 10.9° in the non-dominant hand. The DIP angle was significantly higher in the non-dominant hand (P=.002) in the pelota player group. Non-significant differences were obtained between both hands in the control group (p=.572). Significant differences were obtained in both player and control groups in the dominant hand (P=.001) and in the non-dominant hand (P=.001). Pelota players have a higher DIP angle in the little fingers than the control group. No differences were found in the pelota player group according to their position on the court (P=.742 forward, P=.747 defender) or sport level (P=.345 amateur, P=.346 professional). DISCUSSION: Basque hand-pelota produces post-traumatic acquired clinodactyly of the little finger. The non-dominant hand has a higher DIP joint angle. Clinodactyly poses no functional problems.

Ossifying lesion of the rotator interval.

We report a case of a 15-year-old girl who presented with pain and swelling in the right shoulder. Imaging studies showed an inflammatory process well limited at the rotator interval. Open biopsy showed an osteogenic process that was evident in the postoperative X-rays. Two-year follow-up showed a mature ossification at the rotator interval.

Tratamiento quirúrgico de la enfermedad de Kienböck mediante osteotomía de acortamiento del radio distal / Surgical treatment of Kienböck’s disease by shortening osteotomy of the distal radius

Objetivo. Presentamos los resultados obtenidos a largo plazodel tratamiento quirúrgico de la enfermedad de Kienböckmediante la osteotomía de acortamiento del radio distal.Material y método. Se realizó un estudio retrospectivo en12 pacientes con enfermedad de Kienböck tratados medianteosteotomía de acortamiento del radio distal valorando clínicay radiológicamente los resultados obtenidos a largoplazo. Realizamos una osteotomía transversal en el extremodistal del radio con resección de un segmento óseo de longitudvariable que dependió de la varianza cubital y se estabilizócon una placa de compresión dinámica (DCP) de 6 agujeros.De los 12 pacientes, 8 estaban en estadio II y 4 enestadio III.Resultados. Después de una media de 8,8 años de seguimiento,obtuvimos resultados favorables con ausencia de dolor en10 pacientes (83,3%). El rango de movimiento articular mejorólevemente. No tuvimos ningún caso de pseudoartrosis enel foco de la osteotomía radial. Las radiografías durante el seguimientomostraron remodelación y restauración del semilunaren 2 pacientes, ausencia de progresión de enfermedad en9 y aumento del colapso carpal en uno.Conclusión. Creemos que la osteotomía de acortamientodel radio distal es un procedimiento preventivo que evita elcolapso del semilunar a largo plazo, teniendo su mejor indicaciónen pacientes con dolor y ausencia de cambios degenerativosen las articulaciones carpales vecinas

Aim. We report the long-term results of surgical treatmentof Kienböck’s disease consisting of shortening osteotomyof the distal radius.Materials and methods. A retrospective study was made of12 patients with Kienböck’s disease treated by shorteningosteotomy of the distal radius to clinically and radiologicallyassess long-term results. Transverse osteotomy of thedistal radius was performed with resection of a bone segmentwhose length depended on the lunar variation. The repairwas stabilized with a 6-screw DCP plate. Of the 12 patients,8 had stage II disease and 4 had stage III disease.Results. After a mean follow-up of 8.8 years, we obtainedfavorable results with no pain in 10 patients (83.3%). Thearticular range of movement improved slightly. There wasno case of nonunion of the radial osteotomy site. Follow-upradiographs showed remodelling and restoration of the lunatebone in two patients, absence of disease progression in9, and increased carpal collapse in one.Conclusion. We believe that shortening osteotomy of thedistal radius is a preventive procedure that prevents longtermlunate bone collapse. Its clearest indication is pain andthe absence of degenerative changes in the neighboring carpaljoints

El fijador externo en la extremidad superior catastrófica / The external fixator in the mangled upper extremity

Presentamos la experiencia del uso de la fijación externa en lesiones complejas de la extremidad superior, en un reimplante y cuatro revascularizaciones. Hemos realizado procedimientos de cirugía conservadora primaria y diferida, y en todos ellos el fijador externo ha sido el dispositivo de osteosíntesis utilizado. Pensamos que el fijador externo es capaz de estabilizar la fractura y de facilitar la compleja cirugía del reimplante o de revascularización. Asimismos,es a la vez capaz de asegurar la estabilidad y facilitar los procesos reconstructivos en la cirugía secundaria. Concluimos que la fijación externa puede ser útil en casos seleccionados de cirugía de la extremidad catastrófica. (AU)

Transfer of the second toe to the hand in a patient with Monckeberg's sclerosis.

We present a case of second toe to hand transfer in a 64 year old patient with Monckeberg's sclerosis, who had had first four fingers of his right hand amputated. The result was satisfactory, even though this type of arteriosclerosis is usually considered a relative contraindication to transfer.

[Results of the microsurgical treatment of the peripheral nerve suture in children]. / Resultados del tratamiento microquirúrgico de las suturas de nervios periféricos en niños.

Thirty-five children (20 boys and 15 girls) between 4 and 16 years old who were surgically treated for total nerve section are reviewed. The nerve anastomosis was made with optical microscopy. Epineural suture (10 cases), funicular suture (10 cases), and nerve graft (19 cases) was made. Median (10 sections), ulnar (10 sections), radial (3 sections), and sciatic (4 sections) was repaired. Excellent and good results was obtained in 90% of cases. Daniels and Higuet-Zachary scheme was employed. The minimum follow-up time was 2 year.

[Tumors of nerve sheaths of the peripheral nerves]. / Tumori delle guaine nervose dei nervi periferici.

Objectives of this paper are the analysis of the confidence in the complementary investigation for the differential diagnostic between schwannoma and neurofibroma, and the retrospective evaluation of the therapy based on the consequent follow-up. The study has been conducted on 36 patients, most of them observed by University Clinic of Navarra (Pamplona), and the others by N. Picardi, all with preoperative diagnosis of schwannoma and neurofibroma, localized in 13 cases in peripheral nerves. Diagnostic iter, pathologic definition, therapy and evolution has been evaluated for all of them. In conclusion we feel that this pathology has to be suspected every time we find a tumor with neurologic symptomatology and that surgical indication of exeresis is the most correct in the majority of cases; moreover imaging investigations is rather useful, but if any doubt occurs we must proceed to biopsy or directly to exeresis of the tumor. Our experience shows that schwannoma, thanks to its anatomic patterns, can be treated less radically toward the nerve continuity than neurofibroma, and that the technique of nerve graft could be a useful alternative in this kind of surgery.