[Multiple carpometacarpal fracture-dislocation]. / Fractura-luxación carpometacarpiana múltiple.

Multiple carpometacarpal fracture dislocations are rare lesions despite the increased number of high-energy traumatic injuries. These lesions result from high-energy traumas or, even more frequently, from fall mechanisms involving palmar flexion of the hand. The diagnosis usually requires specific X-ray views to prevent overlooking those lesions. A 27-year-old male presented at the emergency room in our hospital after sustaining a direct trauma on the right hand, in palmar flexion, resulting from a stair fall. The patient had severe inflammation of the dorsal aspect of the hand, pain, limitation, and complete functional disability. X-rays led to diagnosing fracture dislocation of the hamate, capitate and base of the 3rd, 4th, and 5th metacarpal bones. Treatment consisted of closed reduction under fluoroscopic control, fixation with Orthofix threaded nails and placement of a fiberglass cast in functional position for six weeks. The patient's clinical and radiological course was appropriate; healing of the hamate, capitate, and base of the 3rd, 4th and 5th metacarpal bones was attained without necrosis of the carpal bones. The Orthofix threaded nails were removed. After a period of functional rehabilitation the patient course was appropriate, without any functional limitation of the hand joints. This is an unusual lesion with only a few bibliographic references. We think that a specific X-ray study is fundamental to prevent overlooking these lesions. In this case our priority was reconstructing the base to assure articular continuity and stabilization with threaded Orthofix nails, given the high degree of instability of the lesion.

[Conservative surgery as an alternative treatment of a knee osteosarcoma in the presence of a pathological fracture]. / Cirugía de salvamento como alternativa en el tratamiento de osteosarcoma de rodilla ante la presencia de fractura en terreno patológico.

INTRODUCTION: classical osteosarcoma is defined as a very malignant spindle cell sarcoma, characterized by the production of osteoid matrix, it is the most common primary malignant bone tumor. It is most common among males in their twenties. Factors involved include those related with the skeletal growth and development, pathological fractures, and very young patients who are still growing. Conservative surgery is inappropriate; however, preoperative chemotherapy and a good choice of conservative treatment are an alternative. MATERIAL AND METHODS: a 15-year-old male patient presented at the orthopedics service with a diagnosis of a pathological fracture in the distal third of the right femur and a tumor in the lateral aspect of the knee, with pain and limitation of gait. Based on X-rays, a bone scan and a biopsy, the diagnosis of a fibroblastic osteosarcoma, an Enneking IIB lesion, was made. Treatment consisted of conservative surgery with broad tumor resection involving 18 cm of the femur, resection of the vastus medialis and vastus lateralis, release of the femoral bundle, the popliteal and sciatic nerves, as well as placement of a modular stryker tumor prosthesis, with knee replacement. RESULTS: the clinical and radiological course was appropriate. After a 3-week rehabilitation period the patient was able to walk and the lower limb was salvaged. At 5 months there is no evidence of tumor relapse, the patient can walk properly and has recovered the strength. DISCUSSION: this is a case salvage surgery to treat a pathological fracture resulting from a malignant bone tumor. We think that staging is essential to select the treatment. In the case presented herein a comprehensive management is fundamental to the success of conservative treatment.