Reparación del músculo pronador cuadrado en fracturas de radio distal tratadas con fijación interna por abordaje palmar: una revisión sistemática y metaanálisis / Repair of the pronator quadratus muscle in distal radius fractures treated with internal fixation through a palmar approach: a systematic review and meta-analysis

Introducción: el músculo pronador cuadrado funciona como un estabilizador dinámico de la articulación radiocubital distal. Su reparación posterior a la fijación interna con placa de bloqueo volar en fracturas distales del radio es controvertida. Objetivo: determinar si la reparación del músculo pronador cuadrado influye en los resultados clínicos y funcionales de pacientes con fractura de radio distal que se sometieron a reducción abierta y fijación interna con placa de bloqueo volar. Materiales y métodos: se realizó una revisión sistemática y metanálisis. Las bases de datos analizadas fueron PubMed/Medline, Embase y Bireme/Lilacs (búsqueda realizada hasta el 20 de febrero del año 2023). Los términos de búsqueda fueron: distal radius fracture AND volar plate AND pronator quadratus. Se determinó la calidad metodológica según el manual de revisiones Cochrane. Resultados: en total se incluyeron 4 ensayos clínicos aleatorizados de adecuada calidad metodológica, lo cual corresponde al análisis de 213 participantes. Existen mejores resultados en la puntuación DASH a los 12 meses de seguimiento en el grupo de no reparación del músculo pronador cuadrado DM 2,8 [IC 95%: 0,51;5,10]. No hubo diferencias significativas al año de seguimiento en las puntuaciones de dolor, rangos de movilidad de la muñeca, fuerza de agarre e incidencia de complicaciones. Conclusión: no existe evidencia que sustente la reparación rutinaria del músculo pronador cuadrado posterior a la fijación interna con placa de bloqueo volar en las fracturas de radio distal. (AU)

Introduction: the pronator quadratus muscle functions as a dynamic stabilizer of the distal radioulnar joint, and its repair after internal fixation with volar locking plate in distal radius fractures is controversial. Objective: to determine whether the repair of the pronator quadratus muscle influences the clinical and functional outcomes of patients with distal radius fracture who underwent open reduction and internal fixation with volar locking plate. Materials and methods: a systematic review and meta-analysis were conducted. The analyzed databases were Pubmed/Medline, Embase, and Bireme/Lilacs (search performed until February 20th, 2023). The search terms were distal radius fracture AND volar plate AND pronator quadratus. Methodological quality was determined according to the Cochrane Reviewer's Handbook. Results: a total of 4 randomized clinical trials of adequate methodological quality, corresponding to the analysis of 213 participants, were included. Better DASH scores were observed at 12 months of follow-up in the non-repair group of the pronator quadratus muscle, with a mean difference of 2.8 [95% CI 0.51; 5.10]. There were no significant differences at one-year follow-up in pain scores, wrist mobility ranges, grip strength, and incidence of complications. Conclusion: there is no evidence to support routine repair of the pronator quadratus muscle after internal fixation with volar locking plate in distal radius fractures. (AU)

Luxação dorsal complexa da articulação metacarpofalangeana dos dedos longos: relato de caso e revisão da literatura / Complex dorsal dislocation of the metacarpophalangeal joint of the long fingers: case report and literature review

As luxações dorsais da articulação metacarpofalangeana dos dedos são lesões raras, vistas com mais frequência em pacientes jovens, secundárias a trauma por hiperextensão forçada do dedo na mão que estende. São classificadas como simples, quando a redução fechada é possível; ou complexas, quando a redução por métodos fechados não é possível devido à interposição de estruturas periarticulares. É importante distinguir entre uma luxação simples e uma complexa porque sua abordagem e tratamento são diferentes. O objetivo deste estudo é atualizar a abordagem clínica e as diferentes técnicas cirúrgicas utilizadas no tratamento das luxações complexas. Foi realizada uma revisão bibliográfica sobre a luxação dorsal metacarpofalangeana dos dedos longos, excluindo os do polegar, incluindo o Medline (interface PubMed), SciELO e bancos de dados acadêmicos do Google. Todos os artigos revisados concluem que as tentativas de redução incruenta nesses tipos de lesões costumam ser malsucedidas e levar a complicações adicionais. A redução cirúrgica aberta é o método de escolha, permitindo a recuperação anatômica articular com o menor risco de complicações. A imobilização pós-operatória com uma tala de travamento dorsal é recomendada por duas semanas, seguida por reabilitação por terapia ocupacional, esperando-se uma amplitude de movimento normal em seis semanas. A baixa frequência somada ao desconhecimento do médico emergencista ao realizar a manobra de redução pode, muitas vezes, levar à transformação de um simples deslocamento em complexo, tornando-o irredutível e lesionando estruturas adjacentes, por isso, acreditamos ser fundamental conhecer o manejo desta lesão.

Dorsal dislocations of the metacarpophalangeal joint of the fingers are rare injuries that are seen more frequently in young patients secondary to trauma due to forced hyperextension of the finger on the extending hand. They are classified as simple when closed reduction is possible, or complex when reduction by closed methods is not possible given the interposition of peri-articular structures. It is important to distinguish between a simple and complex dislocation because their approach and treatment differ. The objective of this study is to update the clinical approach and the different surgical techniques used in the treatment of complex dislocations. We conducted a bibliographic review on metacarpophalangeal dorsal dislocation of the long fingers, excluding those of the thumb, including the Medline (PubMed interface), SciELO and academic google databases. All the articles reviewed conclude that attempts at closed reduction in these types of injuries are often unsuccessful and often lead to additional complications. Open surgical reduction is the method of choice, allowing joint anatomical recovery with the lowest risk of complications. Postoperative immobilization using a dorsal locking splint is recommended for two weeks followed by rehabilitation by occupational therapy, expecting a normal range of motion at six weeks. The low frequency added to the ignorance of the emergency physician when performing the reduction maneuver can often lead to transform a simple dislocation into a complex one, making it irreducible and injuring adjacent structures, which is why we believe it is essential to know the management of this injury.

Resultados clínico-radiológicos en pacientes jóvenes con fractura articular completa de radio distal tratados con placa palmar bloqueada / Clinical and radiological results in young patients with complete articular distal radius fractures treated with volar locked plate

Introducción: Las fracturas articulares completas de radio distal (tipo AO C) en jóvenes representan un desafío por la demanda funcional de este subgrupo y la necesidad de una reducción articular para evitar la artrosis postraumática. El objetivo es evaluar los resultados clínicos y radiológicos de pacientes <65 años con fracturas de radio distal de tipo C tratadas mediante placa palmar bloqueada. Materiales y Métodos: Se analizaron 292 pacientes con fracturas de radio distal, 71 cumplieron los criterios de inclusión. Cuarenta y cinco eran mujeres (media de la edad 51 años; rango 20-64). El seguimiento promedio fuede 28 meses (rango 6-71). Se realizó una evaluación clínica objetiva (rango de movilidad) y subjetiva de la función (Quick DASH y escala analógica visual funcional) y del dolor (escala analógica visual en reposo y escala de Swanson), además de una valoración radiológica. Resultados: El Quick DASH promedio fue de 8,7 (rango 0-60), con un puntaje en la escala analógica visual funcional de 8,9 (rango 3-10). La movilidad final promedio y comparativa con el lado sano fue: flexo-extensión 91%, pronosupinación 97%, desviaciones cubital-radial 90%. Respecto deldolor, el puntaje promedio en la escala analógica visual fue de 0,4 (rango 0-10). Siempre se recuperaron los parámetros radiológicos extrarticulares, con corrección de 26 de los 29 escalones articulares preoperatorios. Conclusión: En pacientes jóvenes, el tratamiento de las fracturas de radio distal de tipo C con placa palmar bloqueada logra resultados clínicos y radiológicos favorables con corrección de la mayoría de los escalones articulares.

Introduction: The AO type C complete articular distal radius fractures in young patient represent a challenge due to the functional demands of this subgroup of patients and the need for proper articular reduction to prevent post-traumaticarthritis. The aim of the study is to evaluate the clinical and radiological results in patients <65 years with type C distal radius fractures treated with volar locked plate.Methods: Two hundred and ninety two patients with distal radius fractures were evaluated; 71 met the inclusion criteria (45 women and 26 men; mean age 51 years [range 20-64]). The average follow-up was 28 months (6-71). An objective clinical evaluation (range of motion) and a subjective evaluation of the function (Quick DASH and functional visual analogue scale) and of pain (visualanalogue scale at rest and Swanson scale) were conducted, as well as a radiological assessment. Results: Average Quick DASH score was 8.7 (range 0-60) with a functional visual analogue scale score of 8.9 (range 3-10). The average final motion and the comparative motion with the healthy side were: flexion and extension91%, supination 97%, radial-ulnar deviation 90%. As regards pain, average visual analogue scale score was 0.4 (range 0-10). Radiological extra-articular parameters were always recovered, 26 of the 29 preoperative joint steps were corrected. Conclusion: Treatment of type C distal radius fractures in young patients withlocked volar plate shows favorable clinical and radiological results with correction of most articular steps.