Técnica de rescate para prótesis arpe(R) fallida y resultados / Rescue technique for failed arpe(R) prosthesis and results

Introducción: Existen muchas técnicas para el tratamiento de la rizartrosis, ninguna de ellas con clara ventaja sobre las otras. La principal meta del tratamiento de esta, debe ser el alivio del dolor. La prótesis arpeR ha obtenido buenos resultados funcionales y de supervivencia a medio-largo plazo, pero no está exenta de complicaciones. Para su rescate, suelen emplearse las técnicas de Jones o Weilby, con buenos resultados. Objetivo: Descripción de técnica quirúrgica empleada para rescate de prótesis arpeR y de los resultados obtenidos con dicha cirugía. Material y métodos: Análisis estadístico descriptivo con STATA versión 12, dónde se recogen los resultados funcionales de todos los casos de prótesis arpeR, que han sido sometidos a revisión quirúrgica mediante técnica de Weilby sin extracción del vástago implantado; en nuestro centro. Resultados: Los resultados obtenidos han sido satisfactorios y comparables a los que aparecen con el empleo de técnicas de rescate para implantes trapeciometacarpianos ( tMCP) fracasados, en cuanto al alivio del dolor y al rango de movimiento; con un Kapandji medio de 9(0-10), un DASH score medio de 61.36 (18.18-88.63), EVA medio de 3 (0-8), fuerza pinza lateral 1.5 (1-5.5) Kg/cm2 y fuerza de pinza puño 8 (0.5-18)Kg/cm2. Conclusiones: La técnica de Weilby sin extracción de vástago protésico como salvamento de implante arpeR fracasada, es fácilmente reproducible y además obtiene unos resultados, en movilidad y alivio de dolor, comparables a los de otras técnicas de tenosuspensión empleadas en rescates de este tipo

There are many techniques for the treatment of rizarthrosis, none of them with clear advantage on the others. The main goal should be the relief of pain. The placement of prosthesis arpe(R) has obtained good functional results and survival in the medium-long term, but it has also had complications. When this surgery fails, the Jones or Weilby techniques are usually used with good results. Objective: Description of the surgical technique used for arpe(R) prosthesis salvagement and results Material and methods: Statistical descriptive analysis with STATA version 12 of the functional results of all cases of Arpe(R) prosthesis; which have undergone surgical revision through Weilby technique without extraction of the implanted stem, in our center. Results: The results obtained have been satisfactory and comparable to those that appear with the use of other revision techniques for unsuccessful trapeziometacarpal implants; with an average. Kapandji of 9 (0-10), a DASH score average of 61.36 (18.18-88.63), an average EVA of 3 (0-8), lateral clamp force 2.1 (1-5.5.5) Kg / cm2 and Clamp force fist 8 (0.5-18) Kg / cm2. Conclusions: The Weilby technique without prosthetic stem extraction is an easily reproducible procedure that gets good results in mobility and pain, comparable to other tenosuspension techniques used in revisions of unsuccessful Arpe(R) implant

Physeal fracture of the distal femur in a newborn: role of arthrography.

Making the diagnosis of a physeal separation of the distal end of the femur in a newborn is a true challenge. The radiological diagnosis is not always simple and a high index of suspicion is needed. Also, knowing the age of appearance of the ossific nuclei helps in reaching a diagnosis. However, it is imperative to perform a differential diagnosis with other causes that may compromise the life of the newborn. An early diagnosis and adequate treatment are fundamental in avoiding permanent deformity of the affected limb. We present a case report, along with a review of the literature, to describe the clinical and radiological findings that aid in reaching a diagnosis and giving the proper treatment. We also point out the importance of the role of the arthrography and closed reduction as an alternative to simple open reduction.