Revista Iberoamericana de Cirugia de la Mano最新文献

{"title":"Percutaneous Dorsal Approach for Fractures of the Hook of the Hamate: A Less Common but Effective Option Abordaje dorsal percutáneo para las fracturas del gancho del ganchoso: una alternativa menos común pero eficaz","authors":"Borja Gómez, Á. Olea, Virginia Sierra","doi":"10.1055/s-0041-1741322","DOIUrl":"https://doi.org/10.1055/s-0041-1741322","url":null,"abstract":"Abstract Introduction Hook of hamate fractures are rare. The best treatment option is a source of debate; it ranges from conservative to surgical techniques, including resection of the hook or a volar approach followed by internal fixation. These techniques are not exempt from risk. Minimal invasive fixation using a dorsal percutaneous approach and a headless, cannulated mini screw is another option, although not commonly considered. We present a case series of patients who underwent this surgical technique. Methods This is a retrospective review of four patients with nondisplaced hook of hamate fractures treated with dorsal percutaneous fixation. The evaluation included symptoms, physical examination, and radiological (radiographs, magnetic resonance imaging [MRI], and computed tomography [CT]) findings, as well as pre and postoperative strength (determined with a Jamar (JLW Instruments, Chicago, USA) hydraulic dynamometer) and quick disabilities of the arm, shoulder and hand (QuickDASH) scores. Results The union rate was 100% with no associated complications. All patients resumed their preinjury activities 3 months after the surgery and reported they would undergo surgery again if needed. Conclusion This retrospective study shows that safe treatment of nondisplaced hook of hamate fractures with percutaneous dorsal fixation is feasible, with excellent clinical outcomes. In any case, our sample is limited, and further studies are required. Resumen Introducción Las fracturas del gancho del ganchoso son infrecuentes. Se debate el tratamiento óptimo, desde el conservador hasta técnicas quirúrgicas, que incluyen la resección del gancho o un abordaje volar y fijación interna. Estas técnicas no están exentas de riesgo. Una alternativa reciente y segura es la fijación interna mediante un abordaje dorsal percutáneo. Presentamos una serie de casos de pacientes a los que se aplicó esta técnica en fracturas agudas o con retrasos de unión. Métodos En este estudio, se han revisado 4 pacientes con fracturas del gancho del ganchoso no desplazadas, de hasta 9 meses de evolución, intervenidos mediante una fijación percutánea dorsal. Se revisó la sintomatología, la exploración física, y la radiología (radiografías, resonancia magnética [RM] y tomografía computarizada [TC]). Se evaluó la fuerza de presión mediante el dinamómetro de Jamar (JLW Instruments, Chicago, IL, USA) y el puntaje en la versión corta del cuestionario de Discapacidades del Brazo, Hombro y Mano (Quick Disabilities of the Arm, Shoulder and Hand, Quick DASH, en inglés) pre y postoperatorios. Resultados En el 100% de los casos, se consiguió la unión de la fractura, sin complicaciones asociadas. En tres de los cuatro casos, la fractura ocurrió en la mano no dominante. Todos los pacientes volvieron a su actividad habitual tres meses después, y declararon que volverían a operarse con esta técnica si fuera necesario. Conclusión Este estudio retrospectivo muestra que las fracturas no desplazadas del gan","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e90 - e96"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43115876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Lunotriquetral Ligamentoplasty, from the Cadaver Lab to the Clinical Practice Ligamentoplastia lunotriquetral artroscópica, de la sala de disección a la práctica clínica","authors":"M. Cruz-Sánchez, Cristóbal Martínez-Andrade","doi":"10.1055/s-0041-1740093","DOIUrl":"https://doi.org/10.1055/s-0041-1740093","url":null,"abstract":"Abstract Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes. Resumen Introducción El diagnóstico ","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e121 - e127"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45242321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of the Ultrasound in Hand Surgery: Part I Utilidad de la ecografía en la cirugía de la mano: parte I","authors":"Homid Fahandezh-Saddi Díaz, F. Fernández, Á. Horcajadas, Manuel Villanueva Martínez, María Elena Cantero Yubero","doi":"10.1055/s-0041-1739295","DOIUrl":"https://doi.org/10.1055/s-0041-1739295","url":null,"abstract":"Abstract In the last years, ultrasonography (US) of the wrist and hand have increased in popularity. Technical advances led us to improve image quality and have the ability to see superficial soft-tissue structures with high resolution with the patient in our office. The advantages of US are the fact that it is noninvasive, its lack of ionising radiation, low cost, and portability. The dynamic real-time assessment in the office is an additional benefit. Ultrasound can be used in hand surgery for both diagnostic and therapeutic purposes. We can use US for injections with needle guidance, for the evaluation of soft-tissue masses, foreign bodies, tendon injuries, compressive neuropathies, and rheumatologic joint disease. It also helps us perform ultrasound-guided procedures: carpal tunnel syndrome, trigger finger, and intersection syndrome or compartimental syndrome. The aim of the present review is to describe different uses of US in hand surgery to show its important role of providing to the surgeon more information on the diseases of their patients. Resumen En los últimos años, la ecografía de muñeca y mano ha aumentado en popularidad. Los avances técnicos nos llevaron a mejorar la calidad de la imagen y a tener la capacidad de ver estructuras superficiales de tejidos blandos con alta resolución con el paciente en nuestro consultorio. Las ventajas de la ecografía son el hecho de que es no invasiva, su falta de radiación ionizante, el bajo costo y la portabilidad. La evaluación dinámica y en tiempo real en el consultorio es un beneficio adicional. El ultrasonido puede ser utilizado en la cirugía de la mano con fines diagnósticos y terapéuticos. Podemos utilizar la ecografía para inyecciones con guía de aguja, para la evaluación de masas de tejidos blandos, cuerpos extraños, lesiones de tendones, neuropatías compresivas, y enfermedad articular reumatológica. También nos ayuda a realizar procedimientos guiados por ecografía: síndrome del túnel carpiano, dedo en gatillo, síndrome de intersección, o síndrome compartimental. El objetivo de la presente revisión es describir diferentes utilidades de la ecografía en cirugía de mano que muestran el importante papel de la ecografía en ayudar al cirujano a tener más información de la enfermedad del paciente.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e128 - e139"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47107146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Four-Corner Fusion with Locking Dorsal Circular Plate versus Headless Compression Screws: A Clinico-Radiological Comparative Study Artrodesis de cuatro esquinas con placa circular dorsal bloqueada versus tornillos canulados de compresión sin cabeza: estudio clínico-radiológico comparativo","authors":"Francisco Melibosky, Rene A. Jorquera, Felipe Z. Saxton, Pablo Orellana, Diego Junqueras, C. Azócar","doi":"10.1055/s-0041-1739239","DOIUrl":"https://doi.org/10.1055/s-0041-1739239","url":null,"abstract":"Abstract Introduction Four-corner fusion is a technique for the treatment of carpal advanced collapse. It consists of scaphoid excision and arthrodesis of the lunate, triquetrum, hamate, and capitate bones. This can be accomplished with different kinds of osteosynthesis. In the first reports of the use of a circular plate, poor outcomes are described, with high rates of non-union, which decreased in later studies, which highlight certain aspects of the surgical technique. Objective To report our experience with four-corner fusion with the use of a dorsal locking plate (Xpode, Trimed Inc., Santa Clarita, CA, US), and compare it with another traditional fixation method (3.0-mm headless compression screws [HCSs], Synthes, Slothurn, Switzerland), with an emphasis on union, an assessment of the fincitonal outcomes, and the presence of complications. Material and Methods A comparative study of two prospective series of patients operated on through two fixation techniques for four-corner fusion using autologous bone graft from the iliac crest. The first group of patients, evaluated between 2010 and 2012, underwent osteosynthesis with 2 HCSs, with a minimum follow up of 18 months. The second group, evaluated between 2011 and 2014, underwent osteosynthesis with a dorsal locking plate, with a minimium foloow up of 12 months. The patients were operated on by four different surgeons in four centers. The patients were evaluated with radiographs to establish the presence of union and the time it took to occur. In case of doubt, union was confirmed through a computed tomography (CT) scan at 8 weeks postoperatrively. We also assessed the range of motion, the presence of complications, and function through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and a grip strength score. Results We achieved a union rate of 100% in both groups at similar times. In the dorsal locking plate group, we obtained better full range of motion, particularly in wrist extension, which was statistically significant (p = 0.0016), as well as lower DASH scores, which was also statistically significant (p = 0.0066). Complications were only present in two patients in the HCS group. Conclusion Both techniques are valid and reproducible for the treatment of wrists with scapholunate advanced collapse (SNAC) and scaphoid non-union advanced collapse (SLAC). Based on the outcomes, with the Xpode plate, the patients presented better ranges of motion and DASH scores; therefore it may be an excellent fixation option in the open four-corner fusion surgical technique. The entry point and configuration of the HCS are fundamental variables to analyze. The union rate of 100% obtained in the present study contrasts with the high rates of non-union reported in the literature published in the early 2000s. Resumen Introducción La artrodesis de cuatro esquinas es una técnica para el tratamiento de colapsos avanzados del carpo. Consiste en realizar una escafoidectomía asociada a artrodesi","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e105 - e114"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47273752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How our Scientific Society Contributes to a Better World Cómo Nuestra Sociedad Científica Contribuye a un Mundo Mejor","authors":"A. Galán","doi":"10.1055/s-0041-1739308","DOIUrl":"https://doi.org/10.1055/s-0041-1739308","url":null,"abstract":"","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e89 - e89"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43180221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Madelung Deformity: Diagnosis and Treatment Options Deformidad de Madelung: opciones de diagnóstico y tratamiento","authors":"R. K. Oliveira, S. Ribak, J. Brunelli, M. Aita, P. Delgado","doi":"10.1055/s-0041-1739452","DOIUrl":"https://doi.org/10.1055/s-0041-1739452","url":null,"abstract":"Abstract Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment. The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology. When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability. We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD. Resumen La deformidad de Madelung (DM) comprende un aumento de la inclinación volar y cubital de la faceta articular del radio distal, secundaria a una displasia fisaria idiopática. Tal cambio causa un acortamiento radial y la consecuente prominencia cubital distal, junto con dolor en la muñeca y pérdida de movimiento. La cirugía se convierte en una opción en pacientes con deformidad severa que no responden al tratamiento conservador. Las técnicas quirúrgicas clásicas son problemáticas para los adultos, pues son específicas para niños y adolescentes, cuya fisis radial aún está abierta. Muy pocos artículos discuten el tratamiento de pacientes adultos; además, la mayoría se centra en la articulación radiocubital distal y, por tanto, no se acercan al origen de la patología. Al analizar la tomografía computarizada con reconstrucción tridimensional, se observa una característica de la DM, la detención del crecimiento de las porciones volar y cubital del radio distal, lo que provoca la deformidad típica del radio distal que conduce a la falta de cobertura del hueso semilunar. Eso conduce a una subluxación palmar del hueso semilunar y la consiguiente inestabilidad radiocarpiana. Decribimos en este artículo las posibilidades de tratamiento en distintas etapas de evolución, y resumimos las opiniones de los autores sobre la DM.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"49 1","pages":"e140 - e154"},"PeriodicalIF":0.0,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41523740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acrometastases to the Hand and Wrist: A Series of 9 Cases and Review of the Literature","authors":"D. Valverde-Vilamala, A. Sala-Pujals, J. Cebamanos, E. Dominguez-Font","doi":"10.1055/s-0042-1744260","DOIUrl":"https://doi.org/10.1055/s-0042-1744260","url":null,"abstract":"Abstract Introduction  Acrometastases are extremely rare in the hand, with a prevalence of around 0.1% according to the literature. They are normally associated with advanced tumor stages, especially in lung cancer. The present article shows the experience of our center in the management and treatment of these pathologies. Materials and Methods  We report a series of 9 cases treated between 1992 and 2020 in the hand and wrist. Data regarding the primary tumor, the target organ, and survival are analyzed. A review of the cases of acrometastasis reported in the literature is also carried out, emphasizing in how many of then the acral lesion was the first sign of an unknown tumor. Results  Acrometastases predominantly affect male patients aged around 60 years, and the primary tumor that is the cause in most cases is lung cancer, with a very low survival rate after the diagnosis (of approximately 8 months). Discussion and Conclusions  In cases of acral lesion of non-traumatic origin, acrometastases should be considered, especially in patients who have a known primary tumor. In the present series, there were three cases in which the acrometastases were the first sign of a tumor in the patient, and in one of them it was initially treated as whitlow. In the literature, in approximately 50% of the cases, acrometastases are the first sign of the presence of a tumor. Once diagnosed, multidisciplinary medicosurgical treatment is essential to improve the patient's function and pain as much as possible. Resumen Introducción  Las acrometástasis son extremadamente raras en la mano, con una prevalencia alrededor de un 0,1% según la literatura. Normalmente se asocian a patologías tumorales en estadios evolucionados, especialmente el carcinoma de pulmón. En este trabajo se muestra la experiencia de nuestro centro en el manejo y el tratamiento de estas entidades. Materiales y métodos  Describimos una serie de 9 casos tratados entre 1992 y 2020 de acrometástasis en la mano y muñeca. Se analizan datos de tumor primario, órgano diana, tratamiento y supervivencia. Asimismo, se realiza una revisión de los casos de acrometástasis de la literatura, haciendo hincapié en cuántos de ellos la lesión acra fue el primer signo de patología tumoral desconocida. Resultados  Se objetiva que afectan predominantemente a varones alrededor de 60 años, y que el tumor primario causante en la mayoría de los casos es el de pulmón, con una supervivencia del paciente tras el diagnóstico muy baja (alrededor de 8 meses). Discusión y conclusiones  Ante una lesión acra de origen no traumático, hay que tener en cuenta las acrometástasis, especialmente en pacientes que tienen un tumor primario conocido. En esta serie hubo tres casos en los que las acrometástasis fueron el primer signo de la patología tumoral del paciente, y en uno de ellos se le trató erróneamente como un panadizo inicialmente. En la literatura, aproximadamente el 50% de las acrometástasis son el primer signo de patología tumoral.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e19 - e26"},"PeriodicalIF":0.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47186708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scaphometacarpal Stabilization Technique for Repairable Scapholunate Injury","authors":"S. Pajares, J. Gómez-Álvarez, X. Sola-Mallo","doi":"10.1055/s-0042-1743279","DOIUrl":"https://doi.org/10.1055/s-0042-1743279","url":null,"abstract":"Abstract Despite the numerous techniques (both arthroscopic and open) for the treatment of acute scapholunate instability, there is no consensus on which one results in better healing of the ligaments. In the present work, we describe a new surgical technique to achieve stability of the scaphoid that enables the reduction inflexion and pronation of this bone when dissociation is produced. Using a high-strength suture wire with double cortical button anchor (Mini TightRope, Arthrex, Naples, FL, US, or MicroLink, Conmed, Largo, FL, US) stabilization of the scaphoid is achieved to protect ligament healing without the need for postoperative immobilization. Resumen A pesar de las numerosas técnicas (tanto artroscópicas como abiertas) para el tratamiento de la inestabilidad escafolunar aguda, no existe un consenso sobre cuál produce una mejor cicatrización ligamentosa. En este trabajo, presentamos una nueva técnica quirúrgica para conseguir una estabilización escafoidea que permita disminuir la flexión y la pronación del escafoides cuando se produce la disociación. Mediante un cable de sutura de alta resistencia con doble anclaje tipo botón cortical (Mini TightRope, Arthrex, Naples, FL, EEUU, o MicroLink, Conmed, Largo, FL, EEUU), se consigue una estabilización dinámica del escafoides para proteger la cicatrización ligamentosa sin necesidad de inmovilización postoperatoria.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e69 - e74"},"PeriodicalIF":0.0,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43661267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Hemitrapezectomy and Suspension with Mini TightRope for the Treatment of Rhizarthrosis: Outcome in patients in stages Eaton-Littler 2 to 3","authors":"Rene A. Jorquera, Pablo Orellana, Francisco Melibosky, Eduardo Paz, R. Liendo, C. Azócar","doi":"10.1055/s-0042-1743512","DOIUrl":"https://doi.org/10.1055/s-0042-1743512","url":null,"abstract":"Abstract Introduction  Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others. Objective  To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US). Materials and methods  We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification. Results  A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7. Conclusion  Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months). Resumen Introducción  La rizartrosis es una causa común de dolor y compromiso de la función de la mano. La mayoría de los pacientes responden de manera excelente al tratamiento conservador, aunque un pequeño porcentaje requieren algún tipo de procedimiento quirúrgico ante la persistencia de síntomas. Se han descrito diferentes procedimientos quirúrgicos; sin embargo, en la literatura aún no existe consenso respecto a la superioridad de una técnica sobre las demás. Objetivo  Evaluar los resultados clínicos y radiológicos de pacientes con diagnóstico de rizartrosis, en estadios 2 a 3 de la clasificación de Eaton-Littler, operados con técnica de hemitrapezectomía artroscópica y suspensión con Mini TightRope (Arthrex, Naples, FL, EEUU). Materiales y métodos  Se evaluaron retrospectivamente los resultados de pacientes","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e12 - e18"},"PeriodicalIF":0.0,"publicationDate":"2021-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45355812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopically-Assisted Foveal Repair of the Triangular Fibrocartilage Complex: Anchor Fixation versus Trans Osseous Tunnel – A Comparative Study","authors":"C. Azócar, J. L. Cifras, Diego Montenegro, Tomás Barros, Hernán Jara, R. Liendo","doi":"10.1055/s-0042-1742690","DOIUrl":"https://doi.org/10.1055/s-0042-1742690","url":null,"abstract":"Abstract Introduction  The triangular fibrocartilage complex (TFCC) plays a fundamental role in the stability of the wrist, and its foveal insertion is the primary structure that performs this function. Surgical repair of the CFCT is challenging given the complexity of the anatomical structures, and arthroscopically-assisted reinsertion has shown certain benefits. The most commonly used techniques are reinsertion with anchors (RAs) and transosseous tunnels (TOs). Objective  To compare the functional results of patients with acute foveal lesion of the CFCT operated through RAs versus TOs, both with arthroscopic assistance. Materials and methods  A retrospective, observational study of patients operated on for foveal disinsertion of the TFCC. We included patients older than 18 years of age, with a traumatic history and conservative treatment lsting 3 months, with persistent pain and arthro-computed tomography (arthroCT) compatible with foveal disinsertion of the TFCC. Patients treated with the RA technique versus TOs were compared, both with arthroscopic assistance. The variables studied were pain during load according to the visual analog scale (VAS), Mayo score, and ranges of motion of the wrist. Values of p <0.05 were considered statistically significant. Results  We included 24 patients (11 in the RAs group and 13 in the TOs group) With an average age of 28.5 years, 58% of whom were male, without statistically significant differences between the groups. In the whole sample, a decrease in pain of 4.33 points (standard deviation [SD]: 1.16) on the VAS was found, with no statistically significant differences between the groups (p = 0.98). The Mayo score improved in both groups, with an average of 30.09 points (SD: 0.94) in the RAs group, and 31.92 points (SD: 1.32) in the TOs group, and this difference was statistically significant ( p  = 0.0004). Flexion-extension increased by 5.2° (SD: 2.3°) in the RAs group, and by 6.9° (SD: 1.32°) in the TOs group, and this difference was also statistically significant ( p  = 0.01). Pronation improved by 15.9° (SD: 1.7°) in the RAs group, and by 15.8° (SD: 1.72°) in the TOs group, which was not statistically significant ( p  = 0.46), and supination improved by 17.09° (SD: 2.46°) in the RAs group, and by 17.5° (SD: 1.61°) in the TOs group, which was statistically significant ( p  = 0.004). The mean duration of ischemia was of 34.2 minutes (SD: 4.36 minutes) in the TOs group, and of 78.9 minutes (SD: 9.39 minutes) in the RAs group, and this difference was statistically significant ( p  = 0.000). Discussion  In the surgery for foveal reinsertion of the TFCC, both the techniques with anchors and with TOs, are effective in reducing load-bearing pain, improving the ranges of motion of the joints and the functional score. Although we found statistically significant differences between the groups regarding the Mayo score, flexion-extension and supination, these do not exceed the minimally-significant clinical differen","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e3 - e11"},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41742185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}