[Digital artery pseudoaneurysm. Case report and systematic review of the literature]. / Pseudoaneurisma de arteria digital. Reporte de un caso y revisión sistemática de la bibliografía.

INTRODUCTION: aneurysms are focal and permanent dilations of an artery; in pseudoaneurysms, the normal layers of the blood vessel are replaced by fibrous tissue. Due to their low incidence, as well as the diagnostic and therapeutic challenge they represent; our objective is to present the clinical case of a pseudoaneurysm of a digital artery of the hand and to carry out a systematic review of this pathology. MATERIAL AND METHODS: literature search in Medline, using the terms "digital artery" and "aneurysm." Studies of vascular dilation pathology affecting the hand and fingers were incorporated. Studies with pathology of proximal involvement of the hand were excluded. CASE PRESENTATION: a 79-year-old female patient who, after a sharp force trauma to the fifth finger of the left hand, develops a rapidly growing necrotic tumor. She had ultrasound and angiography that suggested hematoma. Surgical management was decided, during which it was observed that the tumor involved ulnar collateral digital artery of the fifth finger. The lesion and the arterial segment involved were resected. Post-surgical course without complications. The histopathological diagnosis of pseudoaneurysm of the lesion was confirmed. DISCUSSION: traumatic etiology is the most frequent cause of digital aneurysms. Risk factors for pseudoaneurysms include sharp force trauma and alterations of the coagulation pathways, as in the case presented. CONCLUSION: the pseudoaneurysm of a digital artery is a rare pathology with great variability of therapeutic management. Surgical resection of the lesion with vascular flow reconstruction is the recommended treatment.

INTRODUCCIÓN: los aneurismas son dilataciones vasculares localizadas y permanentes de una arteria; en los pseudoaneurismas, las capas normales del vaso sanguíneo son reemplazadas por tejido fibroso. Debido a su baja incidencia, así como el desafío diagnóstico y terapéutico que representan; nuestro objetivo es presentar el caso clínico de un pseudoaneurisma de una arteria digital de la mano y realizar una revisión sistemática sobre dicha patología. MATERIAL Y MÉTODOS: búsqueda bibliográfica en Medline, utilizando los términos "arteria digital" y "aneurisma". Se incorporaron estudios de patología de dilatación vascular que afecte la mano y los dedos. Se excluyeron trabajos con patología de afección proximal de la mano. PRESENTACIÓN DE CASO: paciente femenino de 79 años de edad, que posterior a herida cortante de quinto dedo de mano izquierda, desarrolla tumoración necrótica de rápido crecimiento. Contaba con ecografía y angiografía que sugerían hematoma. Se decidió manejo quirúrgico, durante el cual se observó que la tumoración involucraba arteria digital colateral cubital del quinto dedo. Se resecó lesión y segmento arterial involucrado. Cursó postquirúrgico sin complicaciones. Se confirmó el diagnóstico histopatológico de pseudoaneurisma de la lesión. DISCUSIÓN: la etiología traumática es la causa más frecuente de los aneurismas digitales. Los factores de riesgo para los pseudoaneurismas incluyen lesiones penetrantes y alteraciones de la cascada de coagulación, como en el caso presentado. CONCLUSIÓN: el pseudoaneurisma de una arteria digital es una patología rara y con gran variabilidad de manejo terapéutico. La resección quirúrgica de la lesión con la reconstrucción del flujo vascular, es el tratamiento recomendado.

Late consolidation of the scaphoid. Case report and literature review.

Scaphoid fractures are a common wrist injury accounting for 2-7% of all adult fractures. Nonunion is described in 5-12% of cases leading to osteoarthritis. Several classifications have been developed focused on this pathology and its complication. We present a case of a 28 years old male patient with a scaphoid fracture and nonunion who spontaneously consolidates without treatment. We performed a literature review to recognize this pathology, its common evolution and possible treatment options.

Las fracturas de escafoides son una lesión frecuente de la muñeca y representan de 2-7% de todas las fracturas en adultos. La no unión se describe en 5-12% de los casos y conduce a la osteoartritis. Se han desarrollado varias clasificaciones centradas en esta patología y su complicación. Presentamos el caso de un paciente varón de 28 años con fractura y no unión de escafoides que consolida espontáneamente sin tratamiento. Realizamos una revisión bibliográfica para reconocer esta patología, su evolución habitual y las posibles opciones de tratamiento.

[Translated article] The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluations were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

Late consolidation of the scaphoid. Case report and literature review / Consolidación tardía del escafoides. Reporte de un caso y revisión de la literatura

Abstract: Scaphoid fractures are a common wrist injury accounting for 2-7% of all adult fractures. Nonunion is described in 5-12% of cases leading to osteoarthritis. Several classifications have been developed focused on this pathology and its complication. We present a case of a 28 years old male patient with a scaphoid fracture and nonunion who spontaneously consolidates without treatment. We performed a literature review to recognize this pathology, its common evolution and possible treatment options.

Resumen: Las fracturas de escafoides son una lesión frecuente de la muñeca y representan de 2-7% de todas las fracturas en adultos. La no unión se describe en 5-12% de los casos y conduce a la osteoartritis. Se han desarrollado varias clasificaciones centradas en esta patología y su complicación. Presentamos el caso de un paciente varón de 28 años con fractura y no unión de escafoides que consolida espontáneamente sin tratamiento. Realizamos una revisión bibliográfica para reconocer esta patología, su evolución habitual y las posibles opciones de tratamiento.

The use of an anatomical implant compared to a straight LCP decreases extraction in posterior humeral MIPO. / La utilización de un implante anatómico comparado a una LCP recta disminuye su extracción en la osteosíntesis percutánea posterior del húmero.

PURPOSE: Posterior MIPO approach in the humerus has been described by using a 4.5mm LCP plate. Although straight plates have shown good results, they have not been designed to adapt to the distal humeral metaphysis. The goal of the study was to test the null hypothesis that there is no difference in hardware removal after posterior MIPO with either a straight or a pre-contoured plate. METHODS: Patients older than 18 years, who had suffered mid-distal humeral shaft fracture, were treated by a posterior MIPO technique with a locking plate and had a minimum of 12-month follow-up were retrospectively included. Patients were separated into: group 1 (LCP 4.5mm straight plate); and group 2 (3.5mm anatomically shaped plate). Clinical and radiological evaluation were performed in the postoperative period. Patient-reported outcomes and the need of hardware removal because of pain were assessed. RESULTS: Sixty-seven patients fulfilled the inclusion criteria. Twenty-seven patients in group 1 and 40 in group 2. No patient was lost to follow-up. There were no statistical differences between in patient reported outcomes measures. All the fractures healed. Within group 1, 18% (95%CI: 6-38%) of the patients required implant removal while in group 2 this incidence was 0% (95%CI: 0-9%) (P 0.009). CONCLUSION: These results suggest that the use of a 4.5mm LCP compared to an anatomical 3.5mm LCP in posterior MIPO of the humerus generates greater discomfort and therefore leads to a 18% increase in the risk of implant removal.

Galeazzi fracture-dislocations: Long-term prognosis of the distal radioulnar joint.

The aim of the present study was to evaluate long-term functional and radiographic outcome in the distal radioulnar joint (DRUJ) for Galeazzi fracture-dislocation after anatomic reduction and rigid fixation of the radius. Fourteen patients, with an average age of 38 years, presenting with Galeazzi fracture-dislocation treated by open reduction and internal fixation (ORIF) of the radius and closed reduction of the DRUJ were retrospectively evaluated, with a minimum follow-up of 6 years. At final evaluation (mean: 8 years), the DRUJ was objectively and subjectively evaluated for range of motion (RoM), grip strength, ballottement test, pain on axial loading, function on visual analog scale (VAS) and DASH score. Radiographs and dynamic CT scans were performed to screen for DRUJ instability and/or osteoarthritis. Six of the patients had a positive comparative ballottement test, but none reported pain during the maneuver. No significant differences in RoM were found between the injured and uninjured wrist. Mean grip strength in the injured wrist was 77% of the contralateral value. Mean pain on VAS was 0.6. Mean global function on VAS was 9. Mean DASH score was 3. Dynamic CT showed no clear subluxation in any of the patients, and none showed severe articular changes. Our findings suggest that long-term clinical and radiological prognosis for the DRUJ in Galeazzi lesions is favorable when adequate closed reduction of the ulna is achieved after anatomical ORIF of the radius. LEVEL OF EVIDENCE: IV. Therapeutic case series.

Atraumatic Bilateral Instability of Ulnar Nerve and Extensor Carpi Ulnaris in a Patient with Marfan's Syndrome.

INTRODUCTION: Marfan's syndrome is a hereditary, autosomal dominant multisystemic disorder involving connective tissue. Bilateral extensor carpi ulnaris and ulnar nerve (UN) instability is rare, usually caused by the alteration of structures mainly formed by connective tissue. The association between Marfan's syndrome and bilateral instability of UN and extensor carpi ulnaris has never been reported. CASE REPORT: We present the case of a 38-year-old female with no history of trauma, diagnosed with Marfan's syndrome, who developed bilateralinstability of the UN and extensor carpi ulnaris. Bilateral UN transposition and extensor carpi ulnaris tenoplasty were performed. CONCLUSION: Atraumatic bilateral instability of UN and extensor carpi ulnaris is a new rare clinical profile caused by Marfan's syndrome whether standard treatment is successful in a long-term basis in these particular cases of collagen intrinsic pathology remains unclear.

Extensor Tendons Rupture after Volar Plating of Distal Radius Fracture Related to a Dorsal Radial Metaphyseal Bone Spur.

Extensor tendon ruptures due to volar plating in distal radius fractures have mostly been described in relation with technique failures such as screw prominence and drill penetration. We report the case of a 71-year-old female with a C2 distal radius fracture with severe dorsal metaphyseal comminution. The patient underwent surgical treatment with reduction of the large fragments and fixation with a volar locking plate; the small dorsal metaphyseal nonarticular fragments were not reduced. Six months later, the patient developed extensor digitorum communis (EDC) rupture and extensor indicis proprius (EIP) laceration in coincidence with the dorsal comminution turned into a bony spur. The possible association between the extensor tendon injury and the dorsal residual metaphyseal bony spur in the distal radius fractures is unusual but should be taken into account in fracture patterns presenting dorsal comminution.

Total elbow arthroplasty for the treatment of distal humeral fractures. / Artroplastia total de codo para el tratamiento de fracturas del húmero distal.

OBJECTIVE: To report the clinical-functional outcomes of the treatment of humeral distal fractures with a total elbow prosthesis. MATERIAL AND METHODS: This retrospective study was performed in two surgical centres. A total of 23patients were included, with a mean age of 79years, and of which 21 were women. The inclusion criteria were: patients with humeral distal fractures, operated on using a Coonrad-Morrey prosthesis, and with a follow-up of more than one year. According to AO classification, 15fractures were type C3, 7 C2 and 1 A2. All patients were operated on without de-insertion of the extensor mechanism. The mean follow-up was 40 months. RESULTS: Flexor-extension was 123-17°, with a total mobility arc of 106° (80% of the contralateral side). Pain, according to a visual analogue scale was 1. The Mayo Elbow Performance Index (MEPI) was 83 points. Excellent results were obtained in 8 patients, good in 13, medium in 1, and poor in 1. The mean DASH (disability) score was 24 points. CONCLUSION: Treatment of humeral distal fractures with total elbow arthroplasty could be a good treatment option, but indications must be limited to patients with complex fractures, poor bone quality, with osteoporosis and low functional demands. In younger patients, the use is limited to serious cases where there is no other treatment option. LEVEL OF EVIDENCE: Level of Evidence IV.

Posterior minimally invasive plate osteosynthesis (MIPO) of distal third humeral shaft fractures with segmental isolation of the radial nerve.

UNLABELLED: The aim of this study was to evaluate the clinical, radiographic, and functional outcomes of a cohort of patients with distal third humeral shaft fractures treated using a posterior minimally invasive plate osteosynthesis (MIPO) technique. Twenty-one patients were retrospectively evaluated, 13 men and 8 women with an average age of 37 years. The surgery was performed through two posterior incisions away from the fracture site. The radial nerve was identified and protected. The fracture was fixed with a narrow 4.5/5.0mm locking compression plate. After an average follow-up of 22 months, flexion-extension of the elbow was 138°±7°, with a range of motion of 131°. Shoulder motion was 160° in forward flexion, 59° in external rotation, and internal rotation was to the spinous process of 9th thoracic vertebra. Pain severity was 0.5 on the VAS. The DASH score was 9. Average Constant score was 84. MEPI was 97. Fracture union was obtained in all patients. One patient developed transient postoperative radial nerve palsy. These results demonstrate that the posterior MIPO technique is a reliable option for treating distal third humeral shaft fractures. LEVEL OF EVIDENCE: 4.

Non-surgical functional treatment for displaced olecranon fractures in the elderly.

We retrospectively evaluated the clinical and radiological outcomes of a consecutive cohort of patients aged > 70 years with a displaced fracture of the olecranon, which was treated non-operatively with early mobilisation. We identified 28 such patients (27 women) with a mean age of 82 years (71 to 91). The elbow was initially immobilised in an above elbow cast in 90° of flexion of the elbow for a mean of five days. The cast was then replaced by a sling. Active mobilisation was encouraged as tolerated. No formal rehabilitation was undertaken. At a mean follow-up of 16 months (12 to 26), the mean ranges of flexion and extension were 140° and 15° respectively. On a visual analogue scale of 1 (no pain) to 10, the mean pain score was 1 (0 to 8). Of the original 28 patients 22 developed nonunion, but no patients required surgical treatment. We conclude that non-operative functional treatment of displaced olecranon fractures in the elderly gives good results and a high rate of satisfaction.

Comparative clinical study of locking screws versus smooth locking pegs in volar plating of distal radius fractures.

The present study was performed to test the null hypothesis on no difference in stability of fixation after volar plating of intra-articular distal radius fractures (AO C2-C3) with either locking smooth pegs or locking screws in a clinical setting. A retrospective evaluation included adult patients with C2-C3 AO fractures treated with a volar plate with locking smooth pegs or locking screws. Radiographic assessment was performed to evaluate extra- and intra-articular parameters in the early postoperative period and after bone union. Twenty-seven consecutive patients were included. Thirteen cases had fixation with locking screws and 14 had fixation with locking smooth pegs. Both groups had bone fragment displacement after fixation. However, there were no significant differences between the groups either in extra- or intra-articular parameters defined by Kreder et al. (1996). Our study shows that, in a clinical setting, there is no difference in stability fixation between locking screws or smooth locking pegs in C2-C3 distal radius fractures.

Bilateral rupture of the extensor pollicis longus tendon. A case report.

Bilateral rupture of the extensor pollicis longus (EPL) is a rare entity and the few cases that have been reported were associated with an underlying systemic condition such as rheumatoid arthritis or following an injury. We present the case of a patient who was referred to us with a spontaneous rupture of the EPL tendon of the right wrist and that of the left side observed 2 months after tenosynovectomy. The patient had not any pathologic condition or evidence of trauma in both wrists. In the left side, he was operated on and a tenolysis and subcutaneous tendon transposition was performed. Despite this preventive surgery, the patient suffered from a tendon rupture. The possible causes of surgery failure are discussed.

Free Gracilis muscle transfer to restore elbow flexion in brachial plexus injuries.

INTRODUCTION: Restoration of elbow flexion is an important step in managing brachial plexus injuries. After more than one year of functional denervation, the muscle atrophy is significant enough that transferring a free muscle to act as a new effector becomes a treatment option. The goal of this study was to evaluate the effectiveness of transferring a gracilis free muscle, innervated by three intercostal nerves, to restore elbow flexion. MATERIAL AND METHODS: This was a retrospective study of a series of gracilis transfer procedures in 12 men having an average age of 25.6 years (23-37) and average follow-up of 112 months (28-260). The patients were operated on average at 42 months (14-153) following their motor vehicle accident; five had a partial paralysis (C5C6C7) and seven had a complete paralysis (C5-T1). The surgical technique and rehabilitation protocol were the same for all the patients. RESULTS: There were two cases of acute arterial thrombosis (17%) that led to functional failure. When these two cases were excluded from the analysis, all the remaining patients had a useful result (British Medical Research Council score ≥ M4) and 2.5 kg of elbow flexion strength measured on a dynamometer. The strength was 3.8 kg (2.7 to 55) for partial plexus injuries and 1.6 kg (0.3 to 1.5) for complete plexus injuries. For partial injuries, active elbow flexion was 128° and extension -38°, versus 103° and -23° for complete injuries. The average DASH score was 42 for partial injuries and 32 for complete injuries. DISCUSSION: Free Gracilis muscle transfer is a challenging technique that leads to reproducible and encouraging results, but has vascular failure rate that cannot be ignored. When compared to published results, our series provides similar results to primary suturing performed within 6 months for cases of complete paralysis and within 12 months for cases of C5C6C7 partial paralysis; our series was better for cases beyond 12 months.

[Rollover hands: classification of injuries and therapeutic strategy]. / «Mains de portière¼: classification lésionnelle et stratégie thérapeutique.

UNLABELLED: The term Rollover hands (ROHs) corresponds to a loss of compound tissue from the back of the hand. Our aim was to specify the injuries associated with this type of accident and codify the therapeutic strategy. PATIENTS AND METHOD: Twenty-one ROHs were reviewed with an average follow-up of 38 months. Skin coverage included 15 pedicle flaps (two posterior interosseous, 13 pedicled groin flaps), and three free flaps (two external brachial or one parascapular). RESULTS: We identified: seven stage IA injuries where the extensor apparatus could be directly sutured; Seven stage IB injuries requiring a tendon graft; Stage II, like stage 1B but with bone and joint lesions or damage to the wrist extensors as well, and Stage III for which over 50% of the intrinsic muscles had been destroyed. All patients recovered their grasp. The mean active extension deficit for each finger was -20.9° for the whole digital chain and a 194.4° TAM. Palmo-digital grip strength was 51.3% on the controlateral side, and the mean DASH score was 16.1. DISCUSSION: Our study demonstrates the prognostic value of the proposed classification and importance of restoring high-quality skin covering. Reconstruction of the extensor apparatus must be envisaged once the condition of the bone and joints has become stable. Vascularised tendon grafts may be indicated when early mobilisation allowing restoration of a glliding surface around the tendon is impossible, or for loss of substance of over 5 cm. Damage to the intrinsic muscles is a very poor prognostic factor.

Is distal ulna resection influential on outcomes of distal radius malunion corrective osteotomies?

INTRODUCTION: The mechanical repercussions of distal radius malunion on the distal radio-ulnar (DRU) joint are common and inconsistently corrected by radius osteotomy alone. Ulnar resection has thus become a palliative solution. HYPOTHESES: Does ulna resection influence the outcomes of distal radius malunion corrective osteotomies? What preoperative factors warrant preserving the distal radio-ulnar joint? PATIENTS AND METHODS: Twenty-one corrective osteotomies of the radius were retrospectively reviewed. Ulna resection was performed in cases of cartilage damage, joint incongruence, or persistent stiffness in pronosupination after osteotomy of the radius. After the osteotomies, two groups were identified: 10 cases with preservation of the distal end of the ulna (DRU+) and eleven with distal resections (DRU-). RESULTS: At review, all the osteotomies had united, with comparable anatomical restoration of the radial epiphysis for the two groups. We noted a statistically significant gain in mobility after osteotomy for both techniques (but no difference between them) and comparable grip strengths with 89.8% of the contralateral side for the DRU+ group versus 90.4% for the DRU- group. Pain (scale, 0-3) had significantly diminished for both groups decreasing from 1.9 to 0.3 for the DRU+ group and from 2.5 to 1.1 for the DRU- group, with no significant difference between them. The Mayo Clinic Wrist Score and the DASH score did not differ significantly with 73/100 and 13.5 for the DRU+ group compared with 68.2/100 and 20.2 for the DRU- group, respectively. DISCUSSION: These results show that the impact of ulna resection after distal osteotomy of the radius is limited as reflected by radiological correction, mobility and grip strength. However, after resection pain in the ulnar tilt of the wrist due to instability of the distal ulnar stump was noted. Besides cartilage damage, ulnar deviation of over 5mm was, for this series, a constant factor in non-preservation of the DRU joint. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Pronating osteotomy of the radius for forearm supination contracture in high-level tetraplegic patients: technique and results.

We report the results of performing a pronating osteotomy of the radius, coupled with other soft-tissue procedures, as part of an upper limb functional surgery programme in tetraplegic patients with supination contractures. In total 12 patients were reviewed with a mean follow-up period of 60 months (12 to 109). Pre-operatively, passive movement ranged from a mean of 19.2 degrees pronation (-70 degrees to 80 degrees ) to 95.8 degrees supination (80 degrees to 140 degrees ). A pronating osteotomy of the radius was then performed with release of the interosseous membrane. Extension of the elbow was restored postoperatively in 11 patients, with key-pinch reconstruction in nine. At the final follow-up every patient could stabilise their hand in pronation, with a mean active range of movement of 79.6 degrees (60 degrees to 90 degrees ) in pronation and 50.4 degrees (0 degrees to 90 degrees ) in supination. No complications were observed. The mean strength of extension of the elbow was 2.7 (2 to 3) MRC grading. Pronating osteotomy stabilises the hand in pronation while preserving supination, if a complete release of the interosseous membrane is also performed. This technique fits well into surgical programmes for enhancing upper limb function.

Asynchronic steroid activity of Leydig and Sertoli cells related to spermatogenic and testosterone cycle in Phymaturus antofagastensis.

The severe environments where Phymaturus lizards inhabit in the Andes highlands and in Patagonia, Argentina, impose restrictions on their reproduction, offering a framework for the development of life history strategies to overcome hard weather conditions. Among them, prolonged female cycles, asynchrony between sexes in receptivity, and sperm storage in males, were described. Asynchrony in the reproductive timing between males and females is a consequence of different energy requirements for gametogenesis, and often imply the existence of cellular mechanisms to enhance fertilization, such as the asynchronic steroid synthesis between testicular compartments, allowing gametogenesis independently of mating. In the present study ultrastructural and hormone assays were combined for the first time in liolaemids. Specifically, morphological features of steroid activity in Leydig and Sertoli cells, and serum testosterone concentrations have been studied in the lizard Phymaturus antofagastensis. Leydig and Sertoli cells presented morphological features characteristic of steroid synthesis during the spermatogenesis, and evident asynchronic steroid production between testicular compartments. Active Sertoli cells and inactive Leydig cells were observed in spring and autumn, while in mid-summer their steroid activity was synchronic in coincidence with maximal abundance of spermatozoa in epididymis. Serum testosterone concentration was at its maximum in mid-summer (126-230 ng ml(-1)), and minimum in late spring (4-24 ng ml(-1)) and early autumn (2-17 ng ml(-1)). In view of these results, P. antofagastensis males show an original approach to adjust their reproductive activity to physiological and environmental constraints at high latitudes and altitudes in the Andean highlands of Argentina.

Desmoid tumor of the forearm. Reconstructive surgery and functional result.

Functional results after resection-reconstruction operated at the same time. Desmoid tumors, also known as aggressive fibromatosis, are benign locally aggressive tumors with a high rate of recurrence. Most authors recommend surgical treatment with wide-free margin. Achieving margins of normal tissue around an upper extremity lesion without creating significant functional compromise is frequently difficult. Therefore, functional reconstructive surgery is important, considering that for most patients treated for these tumors, the life expectancy is high and considering also that wide resection can affect the function and the aesthetics as well. We present a case of aggressive fibromatosis in the proximal third of the forearm treated by wide resection and reconstructive surgery in one single procedure, with an acceptable functional result with no evidence of recurrence at 3 years of follow-up.

[Dorsally displaced intra-articular distal radius fractures treated by locked palmar plate. Technique and results]. / Les fractures intraarticulaires du radius distal à déplacement postérieur traitées par plaque palmaire à stabilité angulaire. Technique et résultats.

OBJECTIVES: The purpose of this study was to evaluate the results and complications of locked palmar plating in patients with articular fracture of the distal radius. METHODS: Twenty-two patients were reviewed retrospectively. The average age was 68 years. All fractures were classified as Type C according to the AO classification. Clinical and functional examination including range of motion, grip strength, pain and return to previous activities were assessed. Loss of radial height, radial inclination, palmar tilt and ulnar variance were evaluated with preoperative and postoperative radiographs. RESULTS: At an average follow-up of 10 months, the range of motion was 124 degrees in flexion and extension and 178 degrees in pronation and supination. Grip strength was 80% of the opposite side. Fifteen patients were free of pain. Three patients suffered tenosynovitis of the extensor tendons. Radiographic measurements averaged 11 mm radial height, 21 degrees radial inclination, 4 degrees palmar tilt and 1 mm ulnar variance. CONCLUSIONS: The result of this study showed that locked palmar plating of articular distal radius fractures is effective even in cases of metaphyseal comminution with a low rate of complications.