Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis / Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

[Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término / Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

Ruptura del ligamento de Cooper: a propósito de un caso / Cooper ligament tear: a case - report / Rotura do ligamento de Cooper: a propósito de um caso

Presentamos el caso de una paciente mujer de 34 años de edad que presentó ruptura de ligamento de Cooper de la mama izquierda a raíz de movimiento brusco de torsión de tronco. Dicha patología es poco frecuente y es importante considerarla en los posibles diagnósticos diferenciales de una lesión pectoral. En la literatura no se encuentran casos reportados, pero debido al aumento de la participación de la mujer en el deporte consideramos importante tenerlo presente en pacientes que presenten dolor súbito de la pared costal anterior

We report a 34 years-old woman who presented a Cooper's ligament tear after sudden chest torsion. This condition is extremely rare (to our knowledge, this is the first report published in the literature) but its inclusion in the differential diagnosis of traumatic chest conditions must be considered, especially since the woman is increasing the participation in sport in the last decade

Apresentamos o caso de uma paciente mulher de 34 anos de idade que apresentou uma rotura do ligamento de Cooper da mama esquerda devido a um movimento brusco de torção do tronco. Esta patología é pouco frequente e é importante considerá-la nos possiveis diagnósticos diferenciais de uma lesão peitoral. Na literatura no se encontram casos reportados mas devido ao aumento da participação da mulher no desporto consideramos importante tê-lo presente em pacientes que apresentem uma dor súbita da parede costal anterior

Síndrome del ligamento arcuato mediano y hemorragia digestiva alta / Median arcuate ligament syndrome and upper gastrointestinal bleeding

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Réplica: Síndrome del ligamento arcuato mediano y hemorragia digestiva alta / Reply: Median arcuate ligament syndrome and upper gastrointestinal bleeding

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A long styloid process and Collet-Sicard syndrome / Proceso estiloides alargado y síndrome de Collet-Sicard

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The debatable Arcade of Struthers: is it still time to consider it?

The Arcade of Struthers is reported to be a structure that may play a role in ulnar nerve compression in the arm. The aim of this research is to better understand the relationship between the ulnar nerve and this anatomical structure of the medial aspect of the arm, and to investigate its morphology. In 54 fresh arms (26 female, 28 male, 24 left and 30 right limbs), with a median age of 67 years (range 45-83 years), the ulnar nerve and all the surrounding structures were dissected from the brachial plexus to the ulnar groove of the medial epicondyle. We identified muscular fibers from the medial head of the triceps over the ulnar nerve in 12 examined limbs (24%). In all specimens the ulnar nerve was not compressed by any band and no sign of hourglass constriction was found. The extension of the muscular fibers was 34mm (min 20 mm, max 51 mm) and their average distance from the medial epicondyle was 61 mm (min 25 mm, max 80 mm). The findings of this study are not supportive for the presence of an arcade as previously described. Although this structure was reported to be a rare site of ulnar nerve compression at the elbow, it was not described by Struthers. The terminology "Arcade of Struthers" seems to be misleading due to the similarity with the other eponym "Ligament of Struthers"

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A rare presentation of duodenal diverticulum: case report

The gastrointestinal tract is more susceptible to the development of diverticula. Duodenum, next to colon is the common site for diverticula. This case reports the presence of a single extramural diverticulum at the junction of a horizontal and the ascending part of the duodenum in an adult female cadaver during a routine dissection procedure. Suspensory ligament of duodenum containing suspensory muscle of duodenum was found attached to the basal aspect of the diverticulum. Though most of the duodenal diverticula are asymptomatic, awareness of its presence play a major role in treating the complications

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3D computed tomographic mapping of ossified transverse scapular ligaments and their relationship to coracoid, glenoid and acromion: Landmarks assisting safe release for suprascapular nerve decompression

Operative treatment of suprascapular nerve (SSN) entrapment consists of decompression of the nerve by surgical release of superior transverse scapular ligament (STSL) and spinoglenoid ligament (SGL). The surgical explorations rely on the relationship of anatomic landmarks such as coracoid, glenoid and acromion to these ligaments. Anatomical data for the relationship of bony landmarks to ossified STSL and ossified SGL are deficient. The aim of our study was to quantify the radio-anatomic distances from ossified STSL and ossified SGL to bony landmarks. Multidetector CT (128-slice) scans of dry scapulae having ossified superior transverse scapular ligament (STSL) and ossified spinoglenoid ligament (SGL) were acquired. 3D volume rendered reconstruction of ossified suprascapular ligaments, and their distances from Coracoid, Glenoid and Acromion were recorded. In addition, morphometric parameters of unusual bony tunnels in the supraspinous fossa were documented. Twenty-seven dry scapulae having ossified transverse scapular ligaments and two scapulae having bony tunnels were evaluated. The length of ossified ligaments was 1.31-2.31 cm and width was 0.3-0.9 cm. The distances from lateral edge of ossified ligaments to Coracoid was 3.92-4.42cm, to Glenoid was 1.37-3.01cm and to Acromion was 4.43-5.92cm. Knowledge of the 3D morphometry of ossified transverse scapular ligaments described in this study will be helpful in planning their safe endoscopic and open resection. This study uniquely quantifies a rare variant of SGL and bony tunnels in supraspinous fossa

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Tratamiento quirúrgico de la rizartrosis: evaluación de resultados de distintas técnicas / Surgical management of the thumb arthritis: asessment of outcomes of different techniques

Introducción y Objetivo. Larizartrosis o artrosis de la articulación trapeciometacarpiana (TMC) es uno de los principales motivos de consulta en una Unidad de Cirugía de Mano. Ante el fracaso del tratamiento conservador, recomendamos el tratamiento quirúrgico. Existen distintas opciones terapéuticas y la elección debe ser individualizada para cada paciente en función de varios factores: edad, grado de artrosis, demanda funcional, etc. En este trabajo analizamos los resultados obtenidos en nuestra práctica con las distintas técnicas. Material y Método. Entre abril de 2011 y febrero de 2015 intervinimos 97 casos de rizartrosis. La edad media de los pacientes fue de 54.01 años, con claro predominio del sexo femenino (85.5%). La técnica más frecuentemente empleada fue la artroplastia con reconstrucción ligamentaria y suspensión según técnica de Weilby, con 79 casos. En 9 casos realizamos una artroplastia artroscópica (ATK); en 4 una artrodesis TMC; y en 5 una ligamentoplastia. Resultados. De los 97 pacientes pudimos controlar postoperatoriamente a 49, con un seguimiento medio de 18,3 meses. Los pacientes experimentaron una mejoría de la fuerza de pinza del 24.28% con la técnica de Weilby; del 18.74% con la ATK; del 45.75% con la artrodesis TMC; y del 31.42% con la ligamentoplastia. Respecto al dolor, valorado según una escala visual analógica (0-10) la mejoría fue de 5.50, 5.1, 6.34 y 6.33 puntos respectivamente, en relación a la situación preoperatoria. Conclusiones. Los resultados obtenidos nos confirman la utilidad de la artroplastia de suspensión-interposición como técnica de elección para el paciente habitual de rizartrosis. En determinados casos, factores como la edad, la demanda funcional o el grado de degeneración articular nos encaminaran a elegir otras técnicas, buscando satisfacer las necesidades de cada paciente en concreto (AU)

Background and Objective. Osteoarthritis of the thumb carpometacarpal (CMC) joint remains one of the main reasons for visiting a Hand Centre. Whenever the conservative treatment fails, the surgical approach will be offered. This treatment should be indicated individually for each patient, depending on various factors as the age, the degeneration degree, the functional demand and so on. In this paper the author analyse the outcomes of different techniques, based on his own surgical experience. Methods. Between April 2011 and February 2015, 97 cases of thumb arthritis have been treated surgically. The average age of the patients was 54.01 years, with predominance of females (85.5 %). The most frequently used technique was the ligament reconstruction tendon interposition technique, as Weilby's recomends with 79 cases. In 9 cases an arthroscopic arthroplasty was performed (ATK); in 4 patients a CMC fusion; and in 5 a ligamentoplasty. Results. Out of the 97 patients, 49 have been controlled with an average follow up of 18.3 months. Patients referred an improvement in pinch strength of 24.28% in the Weilby's technique group; 18.74% in the ATK group; 45.75 % in the CMC fusion group; and 31.42 % in the ligamentoplasty group. Focus on the pain, assessed by the visual analog scale, the improvement was 5.50, 5.1, 6.34 and 6.33 points respectively, compared to the preoperative situation. Conclusions. These outcomes confirm the usefulness of the suspension - interposition arthroplasty as an ideal technique for the common patient of rizarthrosis. In some cases, some factors such as age, functional demand or the degree of joint degeneration, lead us to look for other techniques in order to satisfy needs patient's request (AU)

Inestabilidad Crónica de Tobillo. Actualización / Chronic Ankle Instability. Update

Los esguinces de tobillo son una de las lesiones más comunes en la vida diaria y deportiva. Hasta un 20% de estas lesiones provocan el desarrollo de una inestabilidad crónica de tobillo. En la exploración clínica destaca la referencia a una sensación de falta de control sobre la articulación. El tratamiento debe comenzar por una rehabilitación funcional y preventiva. Si el tratamiento conservador no es suficiente, la primera opción quirúrgica es la reparación ligamentosa directa o anatómica. Cuando los tejidos no son lo suficientemente resistentes, el segundo grupo de técnicas consiste en la reconstrucción anatómica, con diferentes injertos como refuerzo. Cuando estas opciones fracasan, o en estabilidades muy evolucionadas, existe un tercer grupo de técnicas basadas en la tenodesis o reconstrucciones no anatómicas. Es importante evaluar el estado articular en su conjunto, mediante técnicas como la artroscopia, para poder aportar una respuesta al resto de lesiones asociadas a la inestabilidad

Lateral ankle sprains are among the most common injuries incurred during daily life and sports participation. Up to 20% of these injuries result in the development of chronic ankle instability. In clinical examination revealed a reference to a feeling of lack of control over the joint. Treatment should start with a functional and preventive rehabilitation. If conservative treatment is not enough, the initial surgical option is direct or anatomical ligament repair when the quality of the ruptured ligaments permits. Anatomical reconstruction with autograft or allograft should be performed when the ruptured ligaments are attenuated. Non-anatomical reconstruction should be reserved for unsuccessful cases after anatomical repair or in cases where no adequate ligament remnants are available for reconstruction. Ankle arthroscopy is an important adjunct to ligamentous repair and should be performed at the time of repair to identify and address intra-articular conditions associated with chronic ankle instability

Anomalous formation and branching pattern of the sciatic and pudendal nerves

Multiple nerve variations were observed in the right gluteal region of a 62 year old female which includes origin, course and branching pattern of the sciatic and pudendal nerves. The sciatic nerve was formed by the L4, L5, S1 and S2 in the pelvis, whereas the pudendal nerve was contributed by the S3, S4 and S5. The pudendal was divided into medial and lateral divisions in the gluteal region. The lateral division had joined the sciatic nerve. High division of the pudendal nerve was observed and all its branches originated from the medial division of the pudendal nerve. The inferior rectal nerve passed through the sacrospinous ligament and formed a loop around the ischial spine. The dorsal nerve of the clitoris passed between the sacrospinous and sacrotuberous ligaments. Since iatrogenic injuries to these nerves may occur during surgery, a thorough knowledge of the variation anatomy of the sciatic and pudendal nerves can help to reduce post-operative complications. Moreover, variation anatomy knowledge might guide the radiologist, surgeons and other health professionals to diagnose and treat various neuralgia related to the perineum and gluteal region

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Análisis de las lesiones en gimnastas de competición en tumbling / Analysis of injuries in competition tumbling gymnasts

El propósito de este estudio ha sido identificar y analizar las lesiones más comunes en gimnastas de tumbling en base a las características del entrenamiento, así como las áreas potenciales sobre las que se podrían aplicar medidas de prevención. Se ha llevado a cabo un estudio descriptivo retrospectivo mediante un cuestionario-entrevista a 18 gimnastas de categorías junior y senior (edad 22,6 años ± 5,4 años; peso corporal 65,94 ± 6,28 Kg; y altura 1,69 ± 0,05 cm). Las variables objeto de estudio fueron el tiempo de práctica y las lesiones sufridas por los gimnastas (localización, tipología, severidad, mecanismo de producción y el momento en el que se producen). Se registraron un total de 50 lesiones, (94%) durante el entrenamiento. Las lesiones más numerosas fueron ligamentosas (44%) y musculares (32%). Por localización, el 72% ocurrieron en los miembros inferiores. Los esguinces representaron un 24%, seguido de las contracturas (12%) y roturas (16%). El (40%) de las lesiones fueron moderadas. Respecto a los mecanismos lesionales, resaltar la sobrecarga en el volumen de trabajo (35%) y lesión por repetición técnica defectuosa (27,50%). La fase de la sesión con mayor incidencia lesional fue el trabajo de las series de competición (54%); y a nivel técnico los elementos dobles y con giros en el eje longitudinal (38,22%). Se halló una correlación positiva (p ≤0,05) entre el número de lesiones y la carga semanal de entrenamiento. Los resultados indican la necesidad de establecer metodologías preventivas, sobre todo para las articulaciones del tren inferior: tobillo y rodilla, al suponer el mayor porcentaje de lesiones. Se recomienda el trabajo propioceptivo como método preventivo para los esguinces y el fortalecimiento muscular asociado a la preparación física específica de los músculos estabilizadores de la rodilla, a través de cargas secuenciales que permitan soportar altos volúmenes de entrenamiento (AU)

The purpose of this study has been to identify and analyze the most common injuries in tumbling gymnasts based on the characteristics of training, as well as the potential areas in which prevention measures could be applied. This is a retrospective study through a questionnaire-interview given to 18 gymnasts (age 22.6 ± 5.4 years; body weight 65.94 ± 6.28 Kg; and height 1.69 ± 0.05 cm). The variables studied were the number of years of practice and the injuries suffered by the gymnasts (location, typology, severity, production mechanism and the moment in which they occurred). A total of 50 injuries was registered, (94%) were recorded during training. The most numerous injuries were ligamentous (44%) and muscle injuries (32%). By location, 72% occurred in lower limbs. Sprains were 24%, followed by contractures (12%) and tears (16%). 40% of the injuries suffered were moderately serious. Regarding the injury mechanisms, we would highlight the work volume overload (35%) and injury by a repetitive defective technique (27.50%). The time of the session with most injury load was the complete series training (54%); and a technical level the doubles somersault with twists in the longitudinal axis (38.22%) produced most injuries. A positive correlation (p ≤0.05) was found between the number of injuries and the weekly training load. Results indicate the need for preventive measures, overall to the lower body joints, ankle and knee. The propioceptive training is recommended as preventive method to avoid sprains, and the muscle strengthening associated with a specific physical preparation on knee stabilizing muscles by sequential charges, allowing high training loads (AU)

Genética de la artrosis / Genetics of osteoarthritis

La artrosis (OA) es una enfermedad compleja en la que diferentes factores ambientales interactúan con múltiples factores genéticos. Esta revisión se centra en los estudios que han contribuido a descubrir los factores genéticos de susceptibilidad a la OA. También se tratan con detalle los loci más relevantes en la actualidad, como GDF-5, el locus en el cromosoma 7q22, MCF2L, DOT1L, NCOA3 y los provenientes del estudio arcOGEN. Además, se discuten las diferentes aproximaciones que pueden servir para minimizar los problemas específicos del estudio de la genética de la OA. Entre ellas se encuentran la estandarización de los fenotipos, el estudio de microsatélites y también el uso de otras estrategias de estudio, como metaanálisis de GWAS y análisis basados en genes. Mediante estos nuevos enfoques se espera contribuir al descubrimiento de nuevos factores genéticos de susceptibilidad a la OA (AU)

Osteoarthritis (OA) is a complex disease caused by the interaction of multiple genetic and environmental factors. This review focuses on the studies that have contributed to the discovery of genetic susceptibility factors in OA. The most relevant associations discovered until now are discussed in detail: GDF-5, 7q22 locus, MCF2L, DOT1L, NCOA3 and also some important findings from the arcOGEN study. Moreover, the different approaches that can be used to minimize the specific problems of the study of OA genetics are discussed. These include the study of microsatellites, phenotype standardization and other methods such as meta-analysis of GWAS and gene-based analysis. It is expected that these new approaches contribute to finding new susceptibility genetic factors for OA (AU)

Luxación inveterada de Monteggia. Técnica de Bell-Tawse modificada / Monteggia dislocation inveterate

La lesión de Monteggia consiste en la fractura del tercio proximal del cúbito asociada a la luxación anterior de la articulación radiocubital proximal. Es muy poco frecuente en niños (el 2% de las fracturas de la región del codo) y los casos inveterados son más inusuales. Se han descrito muchas estrategias terapéuticas para su tratamiento, sin que esté clara la necesidad de reconstrucción del ligamento anular. A continuación, describimos la técnica de Bell Tawse modifi cada a propósito de un caso de una paciente de 5+6 años con una lesión de Monteggia inveterada

Monteggia’s injury is a fracture of the proximal ulna which is associated with anterior dislocation of the proximal radioulnar joint. It is not a common injury in children (it only represents 2% of fractures of the elbow) and inveterate cases are even more unusual. Many surgical treatments have been proposed for this injury. Nevertheless, there is not a general agreement regarding the necessity of the annular ligament reconstruction. Here we describe the modifi ed technique of Bell-Tawse in a 5 and a half years patient with inveterate Monteggia injury

Lesión de Monteggia inveterada tratada con la técnica de Bell-Tawse. A propósito de un caso / Inveterate Monteggia injury treated with Bell- Tawse procedure. A case report

Objetivo: La fractura de Monteggia es poco frecuente y los casos inveterados son muy raros. Presentamos el caso de un niño tratado con reducción abierta, osteotomía de cúbito y utilización de fascia tricipital para reconstruir el ligamento anular. Material y Métodos: Varón de 7 años con caída sobre brazo derecho con diagnóstico de fractura de cúbito aislada y tratamiento conservador. A los 4 meses presentaba déficit de flexión de codo y bultoma palpable en fosa cubital que correspondía a cabeza radial luxada. Se practicó técnica de Bell-Tawse asociada a osteotomía de cúbito. Resultados: El paciente evolucionó satisfactoriamente con recuperación funcional completa y asintomático. Únicamente presentaba ligero déficit de pronación pero no producía limitación en sus actividades de la vida diaria. Conclusiones: La habilidad para diagnosticar lesiones de Monteggia ha ayudado a prevenir el complejo problema de las lesiones inveteradas. La técnica de Bell-Tawse es un método efectivo aunque produzca leve pérdida de pronosupinación. Las resultados a largo plazo son mejores que los logrados con la escisión tardía de la cabeza radial

Objetive: Monteggia fractures are not common and inveterade cases are extremely unusual. We resent a case treated by means of open reduction, ulnar osteotomy and a strip of triceps fascia to the reconstruction of the anular ligament. Material and Methods: A 7 year-old man with falling on right arm with diagnosis of ulnar fracture and conservative treatment. By 4 months he presented elbow flexion deficit and a lump in forearm proximal and anterior area. He treated with Bell- Tawse technique and ulnar osteotomy. Results: The patient evolved satisfactorly with complete functional recovery and and he was asymptomatic. The only thing was that he had slight loss of pronation but it didn't report restrictions to his activities of daily living. Conclusion: The ability to diagnose Monteggia injuries has helped to prevent complex problema of inveterate Monteggia injuries. The Bell-Tawse technique es an effective method although it causes a slight loss of pronosupination. The long term results of this procedure are better than those achieved with a late excision of the dislocated radial head