Luxación de los tendones extensores de la mano a nivel de la articulación metacarpofalángica / Luxation of the hand extensor tendons around the metacarpophalangeal joint

Objetivo. La luxación de los tendones extensores sobre la cabeza de los metacarpianos, constituye una entidad poco frecuente en pacientes que no presentan una artritis reumatoide. Sin embargo, con el incremento de actividades deportivas, especialmente aquellas que exigen un contacto físico permanente, el número de casos ha ido aumentando. Método. En cuanto al tratamiento se refiere, hay que distinguir los casos agudos (menos de tres semanas de evolución) de los crónicos, pues en los primeros casos suele ser suficiente la inmovilización, mientras que en los segundos es necesario practicar algún tipo de intervención quirúrgica. Resultados. En el presente trabajo se dan a conocer los resultados obtenidos sobre tres pacientes con dicha patología y a los cuales se procedió a la centralización quirúrgica del tendón mediante técnica de Kilgore (AU)

Objectives: Dislocation of the extensors over the head of the metacarpals constitutes a rare condition in patients who do not present rheumatoid arthritis. Nevertheless, with the increase in sport activities and especially those that demand a permanent physical contact, the number of cases has been increasing. Methods: As far as treatment its goes, it is necessary to distinguish the acute cases (less than three weeks evolution) from the chronic ones as immobilization is usually sufficient in the first case. On the other hand, it is necessary to practice some type of operation in the second case. Results: In the present work, the results obtained on three patients with this pathology on whom surgical centralization of the tendon by means of the Kilgore technique is made known (AU)

Midshaft clavicular non-unions treated with the Herbert cannulated bone screw.

PURPOSE: To assess an alternative technique for the treatment of midshaft non-unions of the clavicle. METHODS: Five patients with symptomatic non-unions of the clavicle were treated with open reduction and intramedullary fixation by using a Herbert cannulated bone screw. Autogenous bone grafting was applied in one case and decortication in the other 4 cases. RESULTS: Review of the clinical and radiological documentation at a mean time of 13 months (range, 9-26 months) postoperatively shows that union was achieved in all 5 cases. There were no complications related to the operation, and no patient needed removal of the implant for protrusion, loosening, or any other cause. CONCLUSION: Midshaft non-unions of the clavicle can be treated successfully using the Herbert cannulated bone screw, which avoids the need for a second operation to remove the implant after bone union.

Rupture of all the flexor tendons in the hand due to malunion of a distal radius fracture.

We report the case of a patient in whom the flexor digitorum superficialis and flexor digitorum profundus tendons to the index, middle, ring and little fingers ruptured 6 years following malunion of a distal radius fracture. There was no history of rheumatoid disease. The distal ulna was displaced volarly and perforated the volar wrist capsule. There was a cumulative biological effect from chronic synovitis and mechanical compression due to the ulnar head impinging upon the normal anatomic course of the flexor tendons to the ring and little fingers. We discuss the physiopathology of this rare lesion and postulate that flexor tendon rupture to the index and middle fingers will occur on the volar surface of the radius when there is a malunion with dorsal tilt.

Estudio biomecánico del tornillo canulado de Herbert en el tratamiento de la pseudoartrosis de clavícula* / Biomechanical study of the Herbert cannulated screw in the treatment of clavicular nonunion

Objetivo. Valorar biomecánica y clínicamente una técnica alternativa quirúrgica para el tratamiento de la pseudoartrosis del tercio medio de la clavícula. Material y método. Estudio mecánico: diecinueve especímenes de clavículas humanas fueron divididos en tres grupos: grupo A, 5 clavículas intactas, grupo B, 5 clavículas osteotomizadas perpendicularmente al eje longitudinal del hueso, en su parte media, y tratadas con placas DCP de 3,5 mm y 6 orificios, y grupo C, 9 clavículas osteotomizadas y tratadas con clavo canulado de Herbert, de 4,5 mm. Todas las clavículas fueron sometidas a ensayos mecánicos en una máquina de ensayos servohidraúlica obteniendo la resistencia máxima (N), la rigidez (N/Mm) y la tensión máxima (Mpa). Resultados. Estudio mecánico: tanto la placa recta DCP como el tornillo canulado de Herbert se comportaron mecánicamente de forma similar. Conclusiones. La ventaja de la síntesis intramedular con tornillo canulado de Herbert es que no requiere una segunda operación para retirar el implante una vez conseguida su consolidación (AU)

Distal interphalangeal joint arthrodesis: treatment with Herbert screw.

From 1996 to 2000, 20 patients with a mean age of 53 underwent 20 arthrodeses with Herbert screws. There were 16 (80%) distal interphalangeal joint (DIP) and 4 (20%) thumb interphalangeal (IP) joint arthrodeses. Average follow-up was 25 months (range, 6-39 months). The diagnoses included rheumatoid arthritis in 10 patients, degenerative arthritis in 4, and post-traumatic arthritis in 6. Arthrodesis relieved pain and restored stability in all patients. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for DIP and 12 weeks for IP joint arthrodesis. Solid osseous union occurred in 19 patients (95%). The average interval to fusion was 8 weeks for distal interphalangeal joint arthrodesis and 12 weeks for interphalangeal joint of the thumb. There were three complications: one delayed union, one nonunion because of a short screw, and one dorsal skin necrosis with amputation. It was shown that distal interphalangeal joint arthrodesis with a Herbert screw is a technique with several advantages: good clinical results, high rates of fusion, early mobilization, and the screw does not need to be removed after the fusion heals. Potential complications may be avoided by using the Herbert mini-screw.

Osteoid osteoma of the coracoid process.

Osteoid osteoma is a small, benign, and painful tumor most commonly affecting the extra-articular portions of the long bones, especially the femur or tibia. Osteoid osteoma of the coracoid process is so rare that we have found only three previously reported cases in the international literature. We describe our experience in managing a case of osteoid osteoma in this unusual location.

Treatment of posttraumatic midshaft clavicular pseudarthrosis with the Herbert cannulated bone screw and autologous bone grafting. A case report.

Pseudarthrosis of the midshaft of the clavicle can be treated successfully using the Herbert cannulated bone screw with no need for a second operation to remove the implant after bone union.