Arthroscopic reconstruction for unstable scaphoid non-union. / Reconstrucción artroscópica de la seudoartrosis inestable del escafoides carpiano.

OBJECTIVE: To evaluate the results of arthroscopic reconstruction for the treatment of unstable scaphoid non-union with cancellous bone autograft. METHODS: 13 patients were treated with a mean age of 26 (18-45) years. The average time from injury until surgery was 14 (6-48) months. Preoperative and postoperative clinical and radiological parameters were evaluated. Mean follow-up was 16.8 (12-36) months. RESULTS: Consolidation was achieved in all cases at 7 (4-10 weeks), no patient had complications or reoperations. Range of motion, pain, functional assessment (DASH questionnaire) and radiological measurements improved compared to preoperative measurements. The average range of flexion improved: flexion 71.9° (55°-80°) to 81.7° (55°-90°), extension 66.3° (30°-80°) to 84.4° (70° -90°), ulnar deviation 21.5 (10°-25°) to 25.5° (20°-45°) and radial deviation 11.9° (5°-25°) to 13.3° (10th-20th). Pain (VAS 0-10) improved from 6.8 (4-10) to 0.7 (0-3). DASH functional scale improved from 36 (12-78) to 8 (0-10). The Scapho-Lunate Angle improved from 67.7° (62°-88°) to 47° (32°-55°), and the Radio-Lunate Angle improved from 30.8° (10° -45°) to 4(0°-10°). CONCLUSION: Treatment of unstable scaphoid non-union with cancellous bone graft assisted by arthroscopy presents good clinical results with a short period of consolidation and recovery.

Tratamiento artroscópico de las fracturas avulsión de espina tibial anterior. Nueva técnica CrossFix con arpones BioSwivelock con FiberTape sin nudos: técnica quirúrgica / Arthroscopic surgery of anterior tibial avulsion fractures

Describimos una técnica quirúrgica sin nudos (Knotless) con arpones Bioswivelock con sutura FiberTape (Arthrex inc. Naples Florida) con técnica cruzada; denominándola técnica CrossFix para reducción y osteosíntesis artroscópica de las fracturas avulsión de espina tibial anterior, logrando reducción anatómica estable, mínimamente invasiva sin la necesidad de realizar la extracción del implante al final del tratamiento. Nuestra técnica es aplicable tanto en pacientes con inmadurez esquelética como en adultos ya que no daña la fisis o cartílago de crecimiento y no requiere una segunda intervención para el retiro del implante; combinando las ventajas de la fijación con suturas de alta resistencia FiberTape, con la tecnología de los implantes sin nudos.

We describe a new surgical technique without knots (knotless technique) with Bioswivelock anchor and FiberTape suture (Arthrex inc. Naples Florida) with crossing technique, calling it CrossFix technique for arthroscopic reduction and internal fixation of avulsion fractures of the anterior tibial tubercle, achieving anatomic reduction, stable, minimally invasively without the need for removal of the implant at the end of treatment. Our technique is applicable to both patients adult and skeletal immaturity as not damage the cartilage growth plate or fisis and does not require a second surgery to remove the implant, combining the advantages of fixation with high strength sutures like the FiberTape, with an implant technology without knots like Bioswivelock.