Revista Iberoamericana de Cirugia de la Mano最新文献

{"title":"Giant Lipomas of the Hand. Our Experience Lipomas gigantes de la mano. Nuestra experiencia","authors":"P. Balvís-Balvís, Javier Yañez-Calvo, M. Castro-Menéndez, M. J. Ferreirós-Conde","doi":"10.1055/s-0040-1716559","DOIUrl":"https://doi.org/10.1055/s-0040-1716559","url":null,"abstract":"Abstract Objective Giant lipomas are benign tumors larger than 5 cm in size that are very uncommun in the hand, with the extant literature limited to case reports and small case series. The aim of the present study is to describe our experience with giant lipomas at the level of the hand, reviewing the most important aspects in relation to their diagnosis and treatment. Material and Methods We present 6 patients treated in our service with giant lipomas of the hand between 2007 and 2015. Four cases only presented difficulty in grasping and mobilizing the hand due to the large size of the lipoma. Two cases were accompanied by a clinical feature of compression of the median nerve in relation to its location within the carpal tunnel. Results All patients underwent surgery, and a complete excision of the lipoma was performed. The functional results have been satisfactory in all cases. Conclusions Giant lipomas of the hand are infrequent tumors of slow growth, generally asymptomatic, although they can cause a compressive pathology due to the great size that they reach. Magnetic resonance imaging is an especially useful test to locate and accurately determine the size of the lesion in view of its surgical excision. After surgery, it is important to make a differential diagnosis with low-grade liposarcomas through an anatomopathological study, since both, macroscopically, have similar characteristics. Resumen Objetivo Los lipomas gigantes son tumoraciones benignas de más de 5 cm de tamaño con localización infrecuente en la mano, limitándose la literatura a casos clínicos o series muy cortas. El objetivo de este trabajo es presentar nuestra experiencia con lipomas gigantes a nivel de la mano, revisando los aspectos más importantes en relación a su diagnóstico y tratamiento. Material y Métodos Se presentan 6 casos de pacientes tratados en nuestro servicio con lipomas gigantes de la mano entre 2007 y 2015. Cuatro casos sólo presentaban dificultad para la prensión y movilización de la mano por el gran tamaño del lipoma. Los dos casos restantes se acompañaron de clínica compresiva del nervio mediano, en relación con su localización dentro del túnel carpiano. Resultados Todos los pacientes fueron intervenidos quirúrgicamente, realizándose una exéresis completa del lipoma. El resultado funcional y estético ha sido satisfactorio en todos los casos. Conclusiones Los lipomas gigantes de la mano son tumoraciones infrecuentes de crecimiento lento, generalmente asintomáticas, aunque pueden producir patología compresiva debido al gran tamaño que llegan a alcanzar. La resonancia magnética es una prueba especialmente útil para localizar y determinar con exactitud el tamaño de la lesión en vista a su exéresis quirúrgica. Tras la cirugía, es importante hacer diagnóstico diferencial con los liposarcomas de bajo grado mediante un estudio anatomopatológico, ya que ambos, macroscópicamente, presentan características similares.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"72 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43787849","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":"Treatment of Sagittal Plane Instability of the Proximal Interphalangeal Joint through Volar Plate Repair","authors":"F. J. García Bernal, E. Nevado Sánchez","doi":"10.1055/s-0042-1743513","DOIUrl":"https://doi.org/10.1055/s-0042-1743513","url":null,"abstract":"Abstract Incompetence of the volar plate of the proximal interphalangeal (PIP) joint can cause instability in the sagittal plane, repetitive dorsal dislocations, pain, and functional disability. The authors herein present five cases of repeated dorsal dislocations of the PIP joint secondary to rupture and incompetence of the volar plate. The patients were aged between 17 and 45 years, and the time elapsed from injury to intervention ranged from 16 weeks to 14 years. Volar plate repair was possible in all cases, resulting in joint stabilization. The mean postoperative follow-up period was of 18 months. Of the five cases, the outcomes were excellent in three, good in one, and fair in one, according to the Catalano et al. 2 criteria. Direct volar plate repair is a reliable technique to treat volar plate incompetence resulting in repeated dorsal dislocation of the PIP joint, regardless of the time from injury to intervention. Resumen La incompetencia de la placa volar de la articulación interfalángica proximal (IFP) puede causar inestabilidad en el plano sagital, luxaciones dorsales de repetición, dolor, e impotencia funcional. En este artículo, los autores presentan cinco casos de luxaciones dorsales de repetición de la articulación IFP secundarias a rotura e incompetencia de la placa volar. Los pacientes tenían edades entre 17 y 45 años, y el tiempo transcurrido entre la lesión y la intervención varió entre 16 semanas y 14 años. La placa volar pudo ser reparada en todos los casos, y se consiguió la estabilización de la articulación. El seguimiento postoperatorio medio fue de 18 meses. De los cinco casos, tres resultados fueron excelentes, uno, bueno, y uno, razonable, según los criterios de Catalano et al. 2 La reparación directa es una técnica fiable para tratar la incompetencia de la placa volar como causa de luxación dorsal de repetición de la articulación IFP, independientemente del tiempo transcurrido entre la lesión y la intervención.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"50 1","pages":"e64 - e68"},"PeriodicalIF":0.0,"publicationDate":"2020-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46957931","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":"Dorsal Support System Fixed to Volar Plate in Distal Articular Radius Fractures Sistema de sostén dorsal fijado a placa volar en fracturas articulares de radio distal","authors":"J. Miró, A. Galán, E. Guerado","doi":"10.1055/s-0040-1708461","DOIUrl":"https://doi.org/10.1055/s-0040-1708461","url":null,"abstract":"Abstract Despite the development of new dorsal low-profile, locked plates to treat distal radius fractures with articular patterns that require a dorsal support, many published series revealed complications associated with such devices. In this paper, we present three cases of comminuted fractures and dorsal die punch fragment treated by osteosynthesis using volar plate and dorsal support screw with double washer fixed to the plate through a mini dorsal approach and, from a volar position, a cup inserted in one of the distal holes of the plate to which a screw and two 7- and 13-mm washers are threaded from the back. This technique is an alternative to other fixation methods, and it may lead to similar functional outcomes and reduce the complications associated with the use of dorsal plates to treat these fractures. Resumen Pese a la aparición de técnicas quirúrgicas con nuevas placas dorsales de bloqueo y bajo perfil para las fracturas de la extremidad distal del radio con patrones articulares que precisan de un sostén dorsal, muchas series publicadas registran complicaciones asociadas a la utilización de esas placas. Se presentan 3 casos de fracturas con conminución y fragmento tipo die punch dorsal tratados mediante osteosíntesis con placa volar y tornillo de sostén dorsal con doble arandela fijado a placa, empleando un mini abordaje dorsal e insertando en un orificio distal de la placa desde el abordaje volar un casquillo al que se rosca desde dorsal un tornillo con dos arandelas de 7 y 13 mm. Esa técnica constituye una alternativa a otros métodos de fijación que podría igualar los resultados funcionales y disminuir las complicaciones asociadas al uso de placas dorsales para el tratamiento de esas fracturas.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"066 - 070"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1708461","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49601320","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":"Distal Articular Fractures of the Humerus: Surgical Approach with Dynamic Elbow external Fixator Fracturas articulares distales del húmero: Abordaje quirúrgico con fijador externo dinámico del codo","authors":"M. Aita, Ricardo Kaempf de Oliveira, Douglas Hideki Ikeuti, G. M. Ruggiero, Fernando Luvizoto de Carvalho, Fábio Lucas Rodrigues","doi":"10.1055/s-0040-1708888","DOIUrl":"https://doi.org/10.1055/s-0040-1708888","url":null,"abstract":"Abstract Purpose To measure clinical and radiographic outcomes using external fixation in distal humeral fractures. Methods A total of 10 elderly patients, with a mean age of 71 (range 64–84 years) years old, with unstable distal humeral fractures were treated by percutaneous reduction and fixation with an articulated external fixator. The patients were assessed on range of elbow motion, patient disabilities of the arm, shoulder, and hand (DASH), and pain visual analog scale (VAS) and radiographic evaluation at 12 months. Results The mean range of motion was 134° of flexion, extension was of - 5°. All of the elbows were clinically stable. The mean VAS was 2.2, and the mean DASH score was 14.3. Radiographic analysis showed satisfactory reduction and consolidation. All of the patients showed congruence of concentric humerus-ulnar and radius and no patient had joint stiffness or posttraumatic arthritis of the elbow. Regarding complications, we observed a patient who presented with pain in the location of the ulnar pin, which was resolved with the removal of the pin. After two months, another patient had pneumonia and died. The follow-up was of 15.44 months. Conclusions A radiographic analysis of the patients showed fracture healing with joint congruity. In the functional clinical aspect, it was noted that patients had functional range of motion Type of study/level of evidence Therapeutic IV Resumen Propósito Medir los resultados clínicos y radiográficos mediante fijación externa en fracturas humerales distales. Métodos Un total de 10 pacientes de edad avanzada, con una edad media de 71 años (rango 64-84 años), con fracturas inestables del húmero distal fueron tratados mediante reducción percutánea y fijación con un fijador externo articulado. Los pacientes fueron evaluados según el rango de movimiento del codo, las discapacidades del brazo, hombro y mano del paciente (DASH) y la escala analógica visual del dolor (VAS) y la evaluación radiográfica a los 12 meses. Resultados El rango de movimiento promedio fue de 134° de flexión, la extensión fue de -5°. Todos los codos eran clínicamente estables. El EVA medio fue de 2,2 y el puntaje DASH medio fue de 14,3. El análisis radiográfico mostró una reducción y consolidación satisfactorias. Todos los pacientes mostraron congruencia de húmero-cubital concéntrico y radio y ningún paciente tenía rigidez articular o artritis postraumática del codo. Con respecto a las complicaciones, observamos a un paciente que presentaba dolor en la ubicación del clavo cubital, que se resolvió con la extracción del clavo. Después de dos meses, otro paciente tuvo neumonía y murió. El seguimiento fue de 15,44 meses. Conclusiones Un análisis radiográfico de los pacientes mostró curación de fracturas con congruencia articular. En el aspecto clínico funcional, se observó que los pacientes tenían un rango de movimiento functional. Tipo de estudio/nivel de evidencia Terapéutica IV","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"002 - 009"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1708888","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45014791","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 Repair of Dorsal Radiocarpal Ligament Tear – Report of Three Cases Reparación artroscópica de la rotura del ligamento radiocarpiano dorsal – Relato de tres casos","authors":"C. Pereira, I. Pedro, C. R. Nunes","doi":"10.1055/s-0040-1708462","DOIUrl":"https://doi.org/10.1055/s-0040-1708462","url":null,"abstract":"Abstract The dorsal radiocarpal ligament (DRCL) is a dorsal capsular ligament with a significant role in carpal stability. We should consider the arthroscopic repair of the DRCL in cases of isolated DRCL tear or when the DCRL tear is the only clinically evident injury. Arthroscopic view of the DRCL tear is better through the volar radial portal. The purpose of the present article is to describe three cases of uncommon DRCL tear in patients with chronical dorsal wrist pain that were treated by arthroscopic repair. This condition can easily be unrecognized by the orthopedic surgeon if it is not specifically searched for. Good results are expected following the arthroscopic repair of an isolated DRCL tear; however, the contribution of the DRCL to the final outcome in combined repairs is difficult to isolate. Resumen El ligamento radiocarpiano dorsal (LRCD) es un ligamento dorsal capsular con un papel importante en la estabilidad del carpo. Debemos considerar la reparación mediante artroscopia del LRCD en casos de rotura aislada de este ligamento o cuando la rotura de LRCD es la única lesión clínicamente evidente. La mejor visualización artroscópica de este ligamento se realiza a través del portal volar radial. El objetivo de este trabajo es describir tres casos clínicos raros de lesión aislada de LRCD en pacientes con dolor crónico en el dorsal de la muñeca tratados mediante reparación artroscópica. Esta patología fácilmente pasa desapercibida para el ortopedista si no se busca específicamente. Podemos esperar buenos resultados con la reparación artroscópica de la lesión de LRCD aislada; sin embargo, la contribución de la reparación de la lesión de LRCD al resultado final del tratamiento, cuando hay lesiones asociadas, es difícil de valorar.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"056 - 060"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1708462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47436153","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":"Use of Vascularized Periosteal Flaps in Upper Extremity Pathology Uso de colgajos vascularizados periósticos en la patología de la extremidad superior","authors":"S. Barrera-Ochoa, Sergi Alabau-Rodriguez, Dorka Liburd, M. González, X. Mir-Bulló, F. Soldado","doi":"10.1055/s-0040-1712095","DOIUrl":"https://doi.org/10.1055/s-0040-1712095","url":null,"abstract":"Abstract Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described. Resumen Los defectos óseos masivos representan un gran reto en cirugía ortopédica. El aporte estructural y biológico mediante colgajos óseos vascularizados libres ha mejorado significativamente su tratamiento. Asimismo, se han utilizado colgajos vascularizados libres provenientes del periostio (CVP) de los niños para tratar defectos óseos, permitiendo más flexibilidad, adaptabilidad al lecho receptor, así cómo mayor potencial osteogénico y osteoinductivo. Sin embargo, se trata de técnicas complejas que pueden generar morbilidad en la zona donante. Para solventarlo, hemos iniciado el estudio anatómico y la aplicación clínica de CVP para defectos masivos recalcitrantes con un diseño pediculado. En este artículo se resumen los aspectos fundamentales de la técnica quirúrgica, la anatomía mediante disecciones cadavéricas, así cómo la aplicabilidad de los CVP pediculados para tratar patología ósea biológicamente desfavorable de la extremidad superior. Se resumen el CVP humeral, los CVP de antebrazo dorso-ulnar y volar-radial, así cómo el CVP del primer metacarpiano, todos ya descritos en artículos previos. Como novedad, se describen los CVP del dorso de la muñeca y la mano (CVP 4–5 Radial y CVP del dorso del 2° metacarpiano). Asimismo, se muestran casos clínicos novedosos sobre la utilización de los CVP en las patologías habituales de la extremidad superior.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"042 - 052"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1712095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44214113","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":"Holding Each Other's Hands during Dark Times Darse las manos en epocas de crisis","authors":"Ricardo Kaempf, V. Carratalá","doi":"10.1055/s-0040-1712094","DOIUrl":"https://doi.org/10.1055/s-0040-1712094","url":null,"abstract":"","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"001 - 001"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1712094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46959261","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":"Metacarpophalangeal Arthrodesis with Resection-suspension Arthroplasty in First Carpometacarpal Osteoarthritis Artrodesis metacarpofalángica asociada con artroplastia de resección-suspension en rizartrosis","authors":"Jose A. Oteo-Maldonado, Patricia Merino-Carretero","doi":"10.1055/s-0040-1712092","DOIUrl":"https://doi.org/10.1055/s-0040-1712092","url":null,"abstract":"Abstract First carpometacarpal joint osteoarthritis (CMC-1) may develop first metacarpophalangeal joint hyperextension (MCP-1). We enrolled patients with CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees treated with resection-suspension arthroplasty and MCP-1 intramedullary arthrodesis with XMCP™ system. Minimum follow-up was five years. We evaluated: thumbinterphalangeal (IP) range ofmotion, key pinch, hand grip, Kapandji, VAS and Quick DASH. Wilcoxon test was uses for statistical analysis. Nineteen patients were reviewed. We found improvement in key pinch, hand grip, VAS and Quick DASH; statistical difference (p < 0.05) was observed in all of them except key pinch. IF thumb range of motion and Kapandji decreased. TMC arthrodesis with XMCP™ system associated with resection-suspension arthroplasty, as a treatment for CMC-1 osteoarthritis and MCP-1 hyperextension ≥40 degrees, achieves good functional results in the medium term. Resumen La artrosis trapeciometacarpiana (TMC) puede desarrollar hiperextensión de la articulación metacarpofalángica (MCF) del pulgar. Presentamos nuestra relación de pacientes revisados con artrosis TMC e hiperextensión MCF 40 grados asociada, tratados con artroplastia de resección-suspensión más artrodesis MCF con el sistema XMCP. El seguimiento mínimo fue de cinco años. Se analizó: arco de movilidad interfalángica (IF) del pulgar, fuerza de pinza y de puño, Kapandji, EVA y Quick DASH. El test de Wilcoxon fue empleado para el estudio estadístico. Se analizaron 19 casos. Hubo mejoría en los parámetros de fuerza de pinza y de puño, EVA y Quick DASH; siendo esta diferencia, estadísticamente significativa en todos ellos salvo en la fuerza de pinza. Los valores de arco de movilidad IF del pulgar y Kapandji disminuyeron. La artrodesis MCF con el sistema XMCP asociada a artroplastia de resección-suspensión, como tratamiento de la rizartrosis cuando hay hiperextensión MCF 40° grados asociada, consigue buenos resultados funcionales a medio plazo.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"027 - 030"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1712092","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43358212","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":"Merkel Cell Carcinoma: Case Report and Literature Review Carcinoma de células de Merkel: Reporte de caso y Revisión de literatura","authors":"Margarida Miranda, P. Mota, P. Cardoso, Alexandre Pereira, Vânia Oliveira","doi":"10.1055/s-0040-1712090","DOIUrl":"https://doi.org/10.1055/s-0040-1712090","url":null,"abstract":"Abstract Merkel Cell Carcinoma is a rare type of aggressive and often fatal neuroendocrine tumor of the skin. We report a clinical case of a 56-year-old female with a Merkel cell carcinoma on the left hand, without distant metastasis, treated with surgical excision of the lesion and radiotherapy. Based on this clinical case a research and review of the literature on this rare neoplasia was carried out. Resumen El carcinoma de células de Merkel es un tipo de tumor de piel neuroendocrino raro, agresivo y con frecuencia mortal. Presentamos un caso clínico de una paciente de 56 años diagnosticada con carcinoma de células de Merkel en el dorso de su mano izquierda, sin metástasis a distancia, tratada con escisión quirúrgica de la lesión y radioterapia. En base a este caso clínico, se realizó una investigación y revisión de la literatura sobre esta rara neoplasia.","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"061 - 065"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1712090","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41409404","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 Treatment of Scaphoid Pseudoarthrosis without Bone Graft: Is it Really Feasible? Tratamiento artroscópico de la seudoartrosis de escafoides sin injerto óseo: ¿Es realmente factible?","authors":"M. Caloia, D. Scotti, D. Fernandez","doi":"10.1055/s-0040-1712089","DOIUrl":"https://doi.org/10.1055/s-0040-1712089","url":null,"abstract":"Abstract Introduction The current management of scaphoid pseudoarthrosis remains controversial, with a failure rate of up to 40% and no “gold standard” treatment. Based on innovative concepts about the osteogenic potential of cells from scaphoid pseudoarthrosis, encouraging results from increased vascularization by radial and ulnar metaphyseal decompression for Kienböck disease therapy and the advantages of minimal surgical trauma provided by percutaneous and arthroscopic techniques, we analyzed prospective outcomes from scaphoid pseudoarthrosis arthroscopic treatment with no bone graft (ATSPsWBG) to determine its feasibility. Materials and Methods Eighty-four non-union scaphoid prospectively treated for ATSPsWBG were evaluated. Patients had, on average, 32.42 years old. The dominant limb was affected in 77.5% of the cases (65 patients). Mean time from injury to surgical intervention was 20.57 months. Twenty-three fractures were initially treated conservatively with orthopedic cast for an average period of 6.3 weeks, including 17 already immobilized at the time of the visit. All patients were grouped according to the classification proposed by the authors (MC & DF), which is based on perioperative studies. Results Bone consolidation was obtained in 77 cases (91.66%) and documented by computed tomography (CT) scans. Seven cases presented no bone consolidation 9 months after the procedure, and four cases required a new surgery. In cystic pseudoarthrosis, the bone defect was filled with a new bone growth even when the cyst exceeded 10 mm. Single photon emission computerized tomography (SPECT) scans revealed an unique pattern, documenting the biological effect of metaphyseal decompression, which is characterized by increased nonspecific irrigation of the radial column. Average postoperative pain assessed using the visual analog scale was 1.04 (range, 0 to 2). Average postoperative functional range was 65.3° for extension (range, 46° to 88°), 69.2° for flexion (range, 55° to 88°), 10.7° for radial deviation (range, 5° to 20°) and 26° for ulnar deviation (range, 20° to 37°). Average Mayo Clinic score was 95. Conclusion The arthroscopic treatment of scaphoid pseudoarthrosis with no bone graft is recommended in young to middle-aged, non-smokers patients with no scaphoid consolidation, with hemorrhagic peteqchiae (arthroscopic Green’s Sign) at the arthroscopic evaluation and in which a CT scan excluded the presence of an excessive sclerosis focus or revealed a very small proximal bone fragment not suitable for screw placement for stable internal fixation. Our experience proved that this is a reproducible and feasible technique. Level of Evidence IV Resumen Introducción En la actualidad, el manejo de la seudoartrosis del escafoides sigue siendo controvertido, con una tasa de fallas que puede llegar hasta el 40% y con ausencia de un “patrón de oro” de tratamiento. Tomando los novedosos conceptos sobre el potencial osteogénico de las células encontradas en l","PeriodicalId":32931,"journal":{"name":"Revista Iberoamericana de Cirugia de la Mano","volume":"48 1","pages":"031 - 041"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1712089","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44944380","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}