Inyección de pintura a alta presión en la mano: una grave lesión que no debe ser subestimada / High-pressure injection of paint into the hand: a severe injury that should not be underestimated

La inyección de alta presión en la mano causa una pequeña lesión cutánea pero severo daño tisular subcutáneo que puede provocar pérdida funcional permanente o amputación. Un tratamiento urgente y adecuado es determinante. Presentamos el caso de un pintor industrial que se inyectó pintura con base de aceite con su pistola de alta presión en el dedo índice izquierdo. Ingresó en Urgencias, donde se le administró profilaxis antitetánica y antibioterapia intravenosa y, antes de transcurridas cuatro horas, se le realizó un desbridamiento quirúrgico. Al año de la lesión el paciente presentaba movilidad activa y pasiva del dedo completa con palidez cutánea, hipersensibilidad y disfunción con la exposición al frío. Hay que reconocer la severidad de estas lesiones con apariencia inicial benigna y realizar un amplio desbridamiento quirúrgico inmediato de todo el tejido isquémico, ya que el retraso en realizarlo se asocia con altas tasas de complicaciones

High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were administered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication

[High-pressure injection of paint into the hand: a severe injury that should not be underestimated]. / Inyección de pintura a alta presión en la mano: una grave lesión que no debe ser subestimada.

High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were adminis-tered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication. Keywords. High-pressure injuries. Paint injection. Hand. Management.

Elongación en Z del ligamentum carpi transversum vs. apertura completa para el tratamiento del síndrome del túnel del carpo / Z-Elongation of the transverse carpal ligament vs. complete resection for the treatment of carpal tunnel syndrome

Introdución. La apertura completa del ligamentum carpi transversum (LCT) es el tratamiento de elección para el síndrome del túnel carpiano. Sin embargo, la pérdida de fuerza de prensión y el dolor sobre la eminencia tenar e hipotenar, denominado «pillar pain» son complicaciones comunes asociadas a dicha técnica. Se han descrito técnicas que reconstruyen dicho ligamento o lo elongan para disminuir estas complicaciones. Objetivo. Analizar la efectividad de la elongación en Z del LCT y la disminución de dichas complicaciones comparándolo con la apertura completa del LCT. Material y método. Se realiza un estudio de intervención prospectivo aleatorizado de 80 pacientes. Los pacientes fueron divididos en 2 grupos: 1) apertura completa de LCT; 2) elongación en Z según técnica modificada de Simonetta. Se analiza la fuerza de agarre, presencia de pillar pain y valoración clínica y funcional mediante el cuestionario Levine. Resultados. No hay diferencias estadísticamente significativas (p>0,05) en la pérdida de fuerza de agarre y presencia de pillar pain entre ambas técnicas en las revisiones realizadas a los 15 días, un mes, 3 meses y un año posquirúrgico. Sí hay diferencias estadísticamente significativas entre los datos preoperatorios y postoperatorios sin embargo, no hay diferencias estadísticamente significativas en el cuestionario de Levine entre ambas técnicas. Discusión. La elongación en Z del LCT es una técnica igual de efectiva que la apertura completa para el tratamiento del síndrome del túnel carpiano pero sin ofrecer ventajas en cuanto a la disminución de fuerza, presencia de pillar pain o mejoría de los resultados funcionales (AU)

Background. Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and 'pillar pain', are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. Objective. The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. Methods. A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. Results. No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. Discussion. In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications (AU)

Z-Elongation of the transverse carpal ligament vs. complete resection for the treatment of carpal tunnel syndrome. / Elongación en Z del ligamentum carpi transversum vs. apertura completa para el tratamiento del síndrome del túnel del carpo.

BACKGROUND: Carpal tunnel syndrome is treated successfully by surgical release of the transverse carpal ligament (TCL). However, persistent weakness of grip and pain over the thenar and hypothenar ends of this ligament, and "pillar pain", are reported to be common complications. In order to reduce these complications, different ligament reconstruction or lengthening techniques have been proposed. OBJECTIVE: The purpose of this study is compare effectiveness and complications of TCL z-lengthening technique with complete TCL section. METHODS: A prospective, randomised, intervention trial was conducted on 80 patients. The patients were divided into 2 groups: 1) complete release of TCL; 2) z-lengthening of TCL according to a modified Simonetta technique. Grip strength, pillar pain and clinical and functional assessment were carried out using the Levine et al. questionnaire. RESULTS: No significant differences were observed (p>.05) in the postoperative reviews between the two groups as regards grip strength loss and pillar pain. There were significant differences between preoperative and postoperative mean Levine scores, but there was no difference in the mean scores of the two procedures at any time. DISCUSSION: In conclusion, according to the results, TCL z-lengthening is more effective than simple division, but there is no identifiable benefit in z-lengthening for avoiding complications.

Osteoporosis transitoria, diagnóstico a considerar en la patología dolorosa de la cadera / Transient osteoporosis, diagnosis to be considerate in the painful pathology of the hip

Presentamos un caso de osteoporosis transitoria de cadera, entidad clínica muy infrecuente que ocasiona osteopenia en la porción proximal del fémur. Las características clínicas del proceso dificultan inicialmente su filiación, por lo que resulta generalmente infradiagnosticada. En el proceso diagnóstico debe ser excluida patología neoplásica, así como afecciones progresivas no tumorales. Sin duda, el diagnóstico diferencial adquiere mayor dificultad en la distinción entre osteoporosis transitoria y necrosis de la cabeza femoral, resultando imprescindible la realización de estudio de imagen con resonancia magnética nuclear para alcanzar finalmente un correcto diagnóstico. Un adecuado tratamiento rehabilitador conlleva la recuperación sin secuelas en la mayoría de los casos, por este motivo es importante considerar esta entidad en el diagnóstico diferencial de la patología dolorosa de la cadera. La clínica y evolución de nuestro paciente permite analizar todos los aspectos del diagnóstico diferencial, así como revisar otras alternativas terapéuticas

We present a case report of transient osteoporosis of the hip (TOH), rare clinical entity that cause osteoporosis of the femoral head. The clinical characteristic of the TOH often difficult the diagnosis, so it is generally underdiagnosed. In the diagnose method we must excluded neoplasic pathology and no malignant progressive processes. We have no doubt that distinction TOH from necrosis of the femoral head is the most difficult topic, and MRI is essential to reach a correct diagnose. An appropriated rehabilitation program leads to a completed recuperation in the vast majority of the cases, this is the reason why it may be considered in the differential diagnose of the pathology of the hip. The clinical and the evolution of our patient allow us to analyse all aspects of the differential diagnosis and to review alternative treatments