Four-Corner Fusion Versus Proximal Row Carpectomy for Scapholunate Advanced Collapse and Scaphoid Nonunion Advanced Collapse Wrist: A Systematic Review and Meta-Analysis.

PURPOSE: Although proximal row carpectomy (PRC) has increasingly been shown to have superior features to four-corner fusion (4CF), individual surgeons may remain convinced of the superiority of one procedure based on personal experience and individual biases. Hence, we sought to perform an updated meta-analysis with some of the largest studies to date to compare outcomes and complications between these procedures in the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists. METHODS: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and 4CF performed for scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist. Primary outcomes included wrist range of motion; grip strength; outcome measures, including Disabilities of Arm, Shoulder, and Hand and Quick Disabilities of Arm, Shoulder, and Hand scores, Patient-Rated Wrist and Hand Evaluation, and visual analog scale pain scores; and surgical complications. RESULTS: Sixty-one studies reported on 3,174 wrists, of which 54% were treated with PRC and 46% were treated with 4CF. The weighted mean follow-up was 61 months (range, 12-216 months). Meta-analysis comparing PRC and 4CF demonstrated that PRC had significantly greater postoperative extension; ulnar deviation; postoperative improvement in extension, flexion, ulnar deviation; and visual analog scale score. No comparisons showed significant differences in grip strength. The percentage of wrists requiring arthrodesis was 5.2% for PRC and 11% for 4CF. There was an 8.9% (57/640 wrists) 4CF nonunion rate and 2.2% (17/789) hardware removal rate after 4CF. CONCLUSIONS: In the treatment of scapholunate advanced collapse and scaphoid nonunion advanced collapse wrists, PRC results in better outcomes and a lower complication rate compared to 4CF. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Proximal Row Carpectomy with and without Capitate Resurfacing: A Preliminary Systematic Review and Meta-Analysis.

BACKGROUND: In wrist salvage, proximal row carpectomy (PRC) has increasingly shown superior outcomes to four-corner fusion (4CF). Furthermore, PRC with resurfacing capitate pyrocarbon implants (PRC + RCPIs) provides a treatment option that may allow patients to avoid 4CF or wrist arthrodesis and help restore natural joint function and distribute loads evenly across the implant, though RCPI has yet to be evaluated on a large scale. We aimed to compare outcomes between PRC and PRC + RCPI for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists. METHODS: A systematic review and meta-analysis was performed per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane were queried for articles on PRC and PRC + RCPI performed for SLAC and SNAC wrist with minimum 12-month follow-up. Primary outcomes included wrist range of motion (ROM), grip strength, and outcome scores including Disabilities of Arm, Shoulder, and Hand (DASH) and QuickDASH scores, Patient-Rated Wrist and Hand Evaluation (PRWHE), and visual analog scale pain scores. RESULTS: Twenty-two studies reporting on 1,804 wrists were included (1,718 PRC alone, 86 PRC + RCPI). PRC + RCPI was associated with greater postoperative radial deviation, but poorer flexion. PRC + RCPI also had significantly lower postoperative QuickDASH (less disability and symptoms) and postoperative PRWHE (lower pain and disability) scores and an improvement in PRWHE compared with PRC. There was no significant difference in grip strength. CONCLUSION: PRC + RCPI demonstrated similar postoperative ROM to PRC alone. While PRC + RCPI was associated with more favorable outcome scores, further research is needed to confirm these findings and assess the incidence and profile of complications related to RCPIs. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.

Recurrence rate and patient-reported outcomes after wedge excision of carpal boss.

The treatment of carpal boss is primarily conservative. Surgical treatment by performing a wedge excision of the bony protrusion, is possible. However, a common belief exists that carpal boss should not be operated because of the high recurrence rate. Additionally, little is known about the clinical outcomes of wedge excision and the preferred post-operative treatment. Patients with carpal boss and persisting pain who underwent wedge excision after conservative treatment were included. They received questionnaires before and three months after surgery. The primary outcomes were pain and hand function measured using patient-reported wrist evaluations (PRWE). Secondarily, recurrence, patient satisfaction and time until return to work were evaluated. These clinical outcomes were also compared between patients who received a plaster splint or a pressure dressing post-operatively. 76 patients were included. Three months after surgery, a significant improvement in PRWE was seen, for both pain and function. A re-operation rate for recurrent carpal boss of 13% was observed. After three months, 58% of patients were satisfied and 73% had returned to work. While no differences in clinical outcomes were found, patients were more satisfied after receiving a pressure dressing than a plaster splint post-operatively. The current study demonstrates encouraging early outcomes after wedge excision, and a low recurrence re-operation rate. Furthermore, a pressure dressing seems preferable post-operatively compared to a plaster splint.

Proximal row carpectomy versus four-corner arthrodesis: a retrospective comparative study.

BACKGROUND: Four-corner arthrodesis with scaphoid excision (FCA) and proximal row carpal resection (PRC) are frequently performed in wrists with post-traumatic Scaphoid Non- Union Advanced Collapse (SNAC)/Scapho-Lunate Advanced Collapse (SLAC) osteoarthritis. The aim of this study was to compare the clinical outcomes of these two procedures. METHODS: This single-center, retrospective cohort study included all patients who had PRC or FCA between January 1st, 2009 and January 1st, 2019 and who were followed up. Follow-up included: mobility (radial deviation, ulnar deviation, flexion, extension), strength (grip test, pinch test), function (QuickDash, patient-rated wrist evaluation [PRWE]), subjective mobility, and global satisfaction scores. RESULTS: Among 25 patients included, 11 had PRC and 14 had FCA with a mean follow-up of 69.5 months [12-132]. Radial deviation was 18° versus 14° (p = 0.7), ulnar deviation was 21° versus 22° (p = 0.15), flexion was 39° versus 30° (p = 0.32), extension was 32.5° versus 29.5° (p = 0.09), grip test compared to the controlateral side was 72% versus 62% (p = 0.53), Quick Dash score was 12.5 versus 17.6 (p = 0.84), PRWE was 18.7 versus 17.6 (p = 0.38), subjective mobility was 7.8 versus 7.5 (p = 0.23), and satisfaction score was 8.7 versus 9 (p = 0.76), respectively, in the FCA group and the PRC group. Re-operation rates were 14% patients in the FCA group and 0% in the PRC group. CONCLUSION: This study found no significant difference between FCA and PRC on strength, mobility, and function in patients with post-traumatic SLAC or SNAC stage II wrist arthritis. Both FCA and PRC seem to be reliable surgical techniques with good outcomes with more revision in the FCA group.

Successful surgical management of a Salter-Harris type I fracture of the accessory carpal bone in a dog.

OBJECTIVE: To describe the successful surgical management of a previously unreported Salter-Harris type I fracture of the accessory carpal bone in a dog. ANIMAL: An 11-week-old intact female Golden Retriever-Poodle cross presented with a history of a marked left forelimb lameness following a suspected fall from a height. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: On physical examination, the patient demonstrated a severe left forelimb lameness and pain on palpation and range of motion of the left carpus. Orthogonal radiographs of the distal left forelimb demonstrated a type I Salter-Harris fracture of the accessory carpal bone with proximal displacement of the palmar fragment. TREATMENT AND OUTCOME: The patient underwent open reduction and internal fixation wherein the fracture was reduced and stabilized with two 1.1-mm Kirschner wires. Postoperatively, the patient was initially managed with a carpal flexion bandage for 2 weeks and then a soft padded bandage was maintained until 4 weeks postoperatively. The patient recovered well and was walking and weight-bearing comfortably following removal of the carpal flexion bandage. Repeat radiographs performed 4 and 8 weeks postoperatively demonstrated adequate fracture healing but showed mild proximocaudal implant displacement. Implant removal was not performed, as the patient was doing well at home and the implant migration appeared static and was not causing clinical morbidity. CLINICAL RELEVANCE: To the authors' knowledge, this was the only reported case of a Salter-Harris fracture of the accessory carpal bone in a dog and the only described case of successful surgical stabilization.

[Dislocation due to injury with trajectory in the scaphoid-trapezoid-trapezoid periscaphoid-perisemilunar bones. Case report and literature review]. / Luxación por lesión con trayecto en los huesos escafoide-trapecio-trapezoidea periescafo-perisemilunar. Reporte de caso y revisión de la literatura.

INTRODUCTION: dislocations of carpal bones without associated fractures are considered a rare injury, the most common mechanism of injury being axial loading with wrist in extension plus ulnar deviation. The literature reports a wide variety of complex carpal injuries, even so, it is possible to identify previously undescribed injuries. OBJECTIVE: to present an atypical case of a patient with an injury to the midcarpal stabilizing mechanism and the stabilizing mechanism of the proximal row of the wrist following trauma to the hand that required carpectomy as definitive surgical treatment. PRESENTATION OF CASE: a 48 year old male patient is presented who is admitted to our hospital unit after presenting injury to the left hand after being run over by a motor vehicle, with axial load mechanism, presenting deformity in the left thoracic extremity, fracture of the proximal metaphysis of the second phalanx of the third finger as well as dislocation of the proximal interphalangeal joint, with traumatic amputation of the second phalanx of the fourth finger plus extensor injury in zone V of the fifth finger with loss of skin coverage of the fourth and fifth finger, attending our hospital unit 24 hours after the injury. CONCLUSIONS: carpal bone dislocations are an orthopedic emergency, with 20% going unnoticed in trauma centers. Early closed reduction is the initial treatment to avoid severe complications, however, surgical treatment is the gold standard for fixation. Carpectomy is considered a mostly adequate sequelae management treatment, however it is well accepted for complex injuries to the wrist stabilization mechanisms, as it can be performed in a short surgical time and early rehabilitation can be initiated and functional ranges of motion can be achieved with low sequelae.

INTRODUCCIÓN: las luxaciones de los huesos del carpo sin presentar fracturas asociadas se considera una lesión infrecuente; el mecanismo de lesión más común es la carga axial con muñeca en extensión más desviación cubital. La literatura reporta una gran variedad de lesiones complejas del carpo; aun así, es posible identificar lesiones no descritas previamente. OBJETIVO: presentar caso atípico de paciente con lesión a nivel del mecanismo estabilizador medio-carpiana y estabilizador de la fila proximal de la muñeca posterior a traumatismo en mano que requirió carpectomía como tratamiento quirúrgico definitivo. PRESENTACIÓN DEL CASO: paciente masculino de 48 años de edad, quien ingresa a nuestra unidad hospitalaria tras sufrir lesión en mano izquierda posterior a ser arrollado por vehículo automotor, con mecanismo de carga axial, presentando en extremidad torácica izquierda deformidad hacia volar, fractura de metáfisis proximal de segunda falange del tercer dedo así como luxación de articulación interfalángica proximal, con amputación traumática de segunda falange del cuarto dedo más lesión extensora en zona V del quinto dedo con pérdida de cobertura cutánea del cuarto y quinto dedos. Acude a nuestra unidad hospitalaria 24 horas después de la lesión. CONCLUSIONES: las luxaciones en huesos del carpo es una urgencia ortopédica, pasando desapercibidas en 20% en centros de traumatología. La reducción cerrada temprana es el tratamiento inicial para evitar complicaciones severas; sin embargo, el tratamiento quirúrgico es el estándar de oro para la fijación de las mismas. La carpectomía se considera un tratamiento mayoritariamente para el manejo adecuado de secuelas; sin embargo, es bien aceptado para las lesiones complejas que se presentan en los mecanismos estabilizadores de la muñeca, dado a que se puede realizar en un tiempo quirúrgico y se puede iniciar una rehabilitación temprana, con lo que se pueden alcanzar rangos de movimientos funcionales y con bajo grado de secuelas.

A Case for Acute Proximal Row Carpectomy for Perilunate Injuries.

Background: Perilunate injuries are complex injuries typically arising from high-energy injuries to the wrist. Standard treatment involves open reduction and internal fixation with ligamentous reconstruction; however, outcomes are fraught with complications including pain, stiffness, and arthrosis. Several case reports have demonstrated the role of proximal row carpectomy as a salvage procedure for complex carpal trauma in the setting of significant cartilage injury or bone loss. The authors believe that proximal row carpectomy may be an appropriate acute treatment in certain patient populations, with functional results similar to those obtained with ligamentous reconstruction. Methods: A retrospective review of two cases with perilunate dislocations managed with primary proximal row carpectomy are presented. Results: At greater than 1-year follow-up, both patients had stable radiocarpal alignment. Quick-DASH scores were 22.7 and 27.3. Conclusion: Primary proximal row carpectomy is a treatment option in the acute setting for perilunate injuries in elderly, lower-demand patients. Functional results are similar to those obtained with ligamentous reconstruction, with a shorter recovery period. Level of Evidence: IV.

Carpectomía proximal en paciente con artrosis de muñeca / Proximal row carpectomy in patient with wrist osteoarthritis

Resumen: La artrosis de la muñeca es un proceso degenerativo, postraumático o idiopático que provoca al paciente dolor, pérdida de la movilidad, inflamación y deformidad. Las opciones quirúrgicas incluyen: artrodesis total de muñeca que produce una mejoría del dolor y disminución de la inflamación, otros tratamientos que permiten movilidad relativa son las artrodesis parciales. Otra solución quirúrgica es la carpectomía o la resección de la primera hilera del carpo, de tal manera que constituya una nueva articulación entre el radio y la segunda fila del carpo, obteniendo una congruencia articular adecuada. Material y métodos: Estudio observacional, descriptivo, serie de casos. Se valoraron 15 pacientes con carpectomía proximal durante el período de Enero de 2007 a Agosto de 2009, a quienes se realizó medición de arcos de movilidad y fuerza mediante las escalas de Mayo-DASH. Resultados: En 80% de los pacientes entre 35 y 64 años se encontró predominio del sexo masculino en 67%. La mejoría del dolor fue evidente, pasando de una media 7.7 en el preoperatorio a 2.7 en el postoperatorio, 10% de los casos presentaron dolor residual. Conclusiones: La carpectomía proximal representa una alternativa terapéutica que permite conservar la movilidad con mejora del dolor en la artrosis de muñeca.

Abstract: The arthrosis of the wrist is a degenerative, traumatic or idiopathic process, which cause problem for patient characterized by pain, loss of mobility, swelling and deformity of the affected wrist. A surgical alternative is proximal row carpectomy, which consists of resection of the lunate, scaphoid and triquetrum, forming a new joint between the radius and the distal row carpus. Material and methods: Observational, descriptive, case series. 15 patients were evaluated who underwent proximal row carpectomy during the period January 2007-August 2009, with clinical follow-up until august 2010 through mayo and DASH scores, measuring strength. Range of motion and pain. 80% of patients were between 35 and 64 years. The predominant sex was male in 67%. The result was satisfactory in 73%, according to the scale of Mayo. The DASH scale in the postoperative period also improves. Conclusions: The proximal carpectomy is a surgical alternative, it preserves some joint mobility, reduced pain and improved disability of the limb.

Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis / Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis

Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado. Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH. Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8. Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. Nivel de Evidencia: IV

Objective: To report the consolidation rate and the outcomes of a series of 22 patients with proximal pole scaphoid nonunion treated with a metaphyseal core decompression and an anterograde self-compressing screw. Methods: We present a prospective series of patients with proximal pole scaphoid nonunion and confirmation of intraoperative bleeding in both fragments. Patients presented with displacement, degenerative changes, proximal pole fragmentation, cavitation at the fracture site, reduced bone length, and necrosis, as well as those with carpal instability, were excluded. X-rays and computed tomography scans were performed to assess consolidation; range of motion and grip strength were recorded, and patients completed a visual analogue scale for pain at rest, pain during activity, and subjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results: Eighteen patients were included. Union was observed in 17 patients. The average follow-up time was 22 months and the average final range of motion was as follows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnar deviation, and 85% for grip strength. The average score on the visual analogue scale was 0 point for pain at rest, 2 for pain during activity, and 9 for function, while average DASH score was 8. Conclusions: Using this simple and reliable technique, we obtained 95% union and very good functional results. Metaphyseal core decompression with an antegrade screw is a valid and effective alternative for the treatment of proximal pole scaphoid nonunion in carefully selected patients. Level of Evidence: IV

Perilunate carpal dislocation. Clinical evaluation of patients operated with reduction and percutaneous fixation without capsular-ligament repair / Luxação perilunar do carpo. Avaliação clínica de casos operados com redução e fixação percutânea, sem reparo cápsulo-ligamentar

ABSTRACT OBJECTIVE: To qualitatively assess surgeries performed in patients with perilunate dislocations without associated fractures, who were operated using the closed reduction and percutaneous fixation method. The follow-up time ranged from one to seven years. METHODS: 628 patient records with traumatic wrist injuries, operated by the same group of Hand Surgeons between 2008 and 2014 due to acute trauma were collected, with a mean follow-up of 3.2 years. Of these, 51 were cases of perilunate fracture-dislocations, and 38 were pure perilunate dislocations without associated fractures; of these, only 32 underwent percutaneous fixation without ligamentous repair, thus meeting the inclusion criteria. Of the nine patients with perilunate dislocations who were treated using the closed reduction and percutaneous fixation method, whose mean age was 38 years (range 26-49 years), the dominant side was the left in two-thirds of the cases, and the predominant trauma mechanism was direct trauma. RESULTS: This study is in agreement with the literature, showing that cases treated early present good results. CONCLUSION: 88% of patients who were treated by closed reduction and percutaneous fixation method maintained their daily activities and were assessed as excellent or good by the Clinical Scoring Chart.

RESUMO OBJETIVO: Fazer uma avaliação qualitativa das cirurgias feitas em pacientes que sofreram luxações perilunares, sem fraturas associadas, que foram operados com o método de redução incruenta e fixação percutânea. O tempo de seguimento variou entre um e sete anos. MÉTODOS: Foram levantados prontuários de 628 pacientes, sob a denominação de lesões traumáticas no punho, operados pelo mesmo grupo de cirurgiões de mão, entre 2008 a 2014, com seguimento médio de 3,2 anos, devido a traumas agudos. Desses, 51 foram casos de fraturas-luxações perilunares, 38 eram luxações perilunares puras, sem fraturas associadas; dessas, apenas 32 tiveram fixação percutânea, sem reparo ligamentar, contemplaram assim os requisitos da pesquisa. Dos nove pacientes com luxações perilunares que foram tratados pelo método de redução fechada e fixação percutânea, com média de 38 anos (26 a 49), o lado dominante foi o esquerdo em 2/3 dos casos, o mecanismo de trauma predominante foi o direto. RESULTADOS: Este estudo convergiu com outros trabalhos na literatura, mostrou que os casos tratados precocemente apresentam bons resultados. CONCLUSÃO: Mantiveram suas atividades de vida diária e foram avaliados como excelentes ou bons pelo Clinical Scoring Chart 88% dos pacientes que foram tratados pelo método de redução fechada e fixação percutânea

Fractura luxación axial del carpo. Reporte de tres casos y revisión de la literatura / Axial-fracture dislocation of the carpal bone, report of three cases and literature review

Reportamos tres casos de fractura de luxación axial del carpo tratados en nuestro servicio. Los tres, hombres entre la tercera y cuarta décadas de la vida, que sufrieron accidentes laborales por aplastamiento. En todos los casos se realizó reducción abierta y estabilización con clavillos, posteriormente fueron enviados a medicina física y rehabilitación. Se valoró la función de la muñeca a los diez meses con la escala de la Clínica Mayo para la muñeca (Mayo Wrist Score) y se tomaron estudios radiográficos para evaluar sus resultados postoperatorios. En este escrito se exponen tres ejemplos de pacientes que sufrieron estas lesiones con desenlaces "bueno", "satisfactorio" y "pobre".

We report three cases of axial-fracture dislocation of the carpal bone treated in our department. The three men were between thirty and forty years old who had a work related crushing fracture. We performed an open reduction and stabilization with pins in all cases; patients were then referred to physical medicine and rehabilitation. We assessed the wrist function at ten months using the Mayo Wrist Score and with X-rays to evaluate postoperative results. In this summary we present three examples of patients who suffered these injuries with "good", "satisfactory" and "poor" outcomes.

Osteotomía de horizontalización de la glenoide radial en la seudoartrosis del escafoides carpiano / Ostéotomie d'horisontalisation de la glène radiale dans la pseudarthrose du scaphoïde carpien / Horizontalization osteotomy of the radial glenoid in seudoarthrosis of the carpal scaphoid bone

Objetivo: presentar los resultados de una osteotomía de cierre cuneiforme del extremo distal del radio para suprimir el dolor, mejorar la función, movilidad y fuerza en pacientes portadores de artrosis de la articulación radio-carpiana, secundaria a una seudoartrosis del escafoide. Además lograr su introducción en el arsenal terapéutico cubano. Métodos: de enero de 2009 a junio 2010 se realizaron 11 osteotomías de horizontalización de la glenoide radial en 7 trabajadores manuales y 4 intelectuales, del sexo masculino, con una edad promedio de 36 años (entre 24 y 49 años); y un tiempo de latencia promedio de 6 años (entre 1 y 14 años). La técnica consistió en la resección de una cuña ósea, 2 cm proximal al extremo de la apófisis estiloides, base lateral de 0,5 a 1 cm y centrada en la articulación radio cubital distal, sin modificación de la longitud del radio. Resultados: se evaluaron mediante la aplicación del score de Cooney con resultados excelentes en 6 pacientes (54,5 por ciento), buenos en 4 (36,3 por ciento) y regulares en 1 (9,2 por ciento).Todos pudieron incorporarse a sus labores. Conclusiones: la osteotomía de horizontalización produce una disminución marcada del dolor al disminuir la presión entre las superficies articulares del radio y el escafoide, lo cual redunda en una mayor movilidad, fuerza y función de la mano(AU)

Objective: to present the results of a wedge osteotomy of the distal radius to alleviate pain, improve function, mobility and strength in patients with arthrosis in the radio - carpal joint secondary to seudoarthrosis in the scaphoid bone. Also, to introduce it in the Cuban therapeutic arsenal. Methods: from January 2009 to June 2010, 11 horizontalization osteotomies of the radial glenoid were performed in 7 manual workers and 4 intellectual ones, male, with an average age of 36 years (between 24 and 49 years) and an average latency time of 6 years (between 1 and 14 years). The technique consisted on the resection of the cuneiform bone 2 cm proximal to the terminal portion of the styloid apophysis, with a lateral base of 0.5-1 cm and centred in the distal radioulnar joint without modification of the length of the radius. Results: patients were assessed by applying the Cooney score with excellent results in 6 of them (54.5 percent), good in 4 (36.3 percent) and regular in 1 patient (9.2 percent). All patients could return to work. Conclusions: horizontalization osteotomy produces a marked pain reduction when diminishing pressure between joint surfaces of the radius and the scaphoid what leads to a greater mobility, strength and function of the hand(AU)

But: ce travail est visé à présenter les résultats d'une ostéotomie de fermeture cunéiforme de la portion distale du radius afin de soulager la douleur, d'améliorer la fonction, la mobilité et la force chez les patients atteints d'arthrose de l'articulation radio-carpienne, après une pseudarthrose du scaphoïde, et d'aboutir aussi à son introduction dans l'arsenal thérapeutique cubain. Méthodes: onze ostéotomies d'horisontalisation de la glène radiale ont été effectuées de janvier 2009 à juin 2010 chez 7 travailleurs manuels et 4 intellectuels, du sexe masculin, âgés de 36 ans en moyenne (entre 24 et 49 ans), et un temps moyen de latence de 6 ans (entre 1 et 14 ans). La technique a consisté en la résection d'un coin osseux, 2 cm de la portion proximale de l'apophyse styloïde, base latérale de 0,5 à 1 cm, et centrée sur l'articulation radio-cubitale distale, sans modifications de la longitude du radius. Résultats: six patients ont été évalués par l'échelle de Cooney avec des résultats excellents (54,5 pourcent), 4 patients avec de bons résultats (36,3 pourcent), et 1 patient avec des résultats passables (9,2 pourcent). Tous ces patients se sont réincorporés à la vie quotidienne. Conclusions: l'ostéotomie d'horisontalisation favorise le soulagement de la douleur, en diminuant la pression entre les superficies articulaires du radius et du scaphoïde, et en récupérant la mobilité, la force et la fonction de la main(AU)

Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study

OBJECTIVE: To compare the functional results of carpectomy and four-corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS: In this prospective randomized study, 20 patients underwent proximal row carpectomy or four-corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS: Both proximal row carpectomy and four-corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS: Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non-union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.

Pathology and therapeutic results in patients with intraosseous ganglia of the carpal bone / Patología y resultados terapéuticos en los pacientes con ganglión intraóseo del hueso carpiano

This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.

Este estudio evaluó la patología y resultados terapéuticos de siete pacientes con ganglión intraóseo del hueso carpiano. La edad promedio en el momento de la cirugía fue 27.6 años. Las lesiones se localizaban en la fila proximal del carpo en seis pacientes y en la fila distal carpiana solamente en uno. El tratamiento quirúrgico se realizó en todos los pacientes con buena unión ósea. Ninguno tuvo dolor durante la actividad o el reposo, y no había tenido lugar recurrencia alguna. El ganglión intraóseo en cuatro pacientes fue de tipo idiopático, y en los otros tres pacientes fue de tipo penetrante. Aunque el ganglión intraóseo del hueso carpiano se informa como una enfermedad rara, se reportaban 159 casos en la literatura. La patología consistía en un desarrollo intra- o extraóseo, con variación, pero la mayoría de los casos se localizaban en la fila proximal carpiana.

Resultados funcionales de carpectomía proximal en estadios avanzados en pacientes con enfermedad de Kienbock / Functional results of proximal carpectomyin advanced Kienbock disease

La carpectomía proximal es una de las técnicas más recomendadas para los pacientes con enfermedad de Kienbock en estadios avanzados (IIIa y IIIb). Se estudiaron 5 pacientes sometidos a carpectomía proximal en un periodo de 17 meses. Los resultados mostraron dorsiflexión de 58,8%, flexión palmar de 43,7% y fuerza de 15 Kg respecto al lado no operado. Un paciente presentó dolor persistente con gran limitación funcional. Los resultados clínicos de estos pacientes no alcanzaron los rangos de movimiento y fuerza reportados en la literatura después de esta intervención, posiblemente por el tiempo tan corto de seguimiento.

Portales artroscopicos radiocarpianos y mediocarpianos: anatomia aplicada y tecnica quirurgica / Radiocarpal and midcarpal arthroscopic portals: anatomy and surgical technique

En este trabajo se presentan una serie de medidas generales para la realizacion de artroscopias de muñeca. Se hace una introduccion con la anatomia aplicada y la tecnica quirurgica basica para la colocacion de los diferentes portales y la aplicacion clinica de los portales mas utilizados para la artroscopia de muñeca tanto radiocarpiana como mediocarpiana.

Penetrating type intraosseous ganglion cyst of the lunate bone / Ganglión intraóseo penetrante del semilunar

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Los gangliones intraóseos de los huesos carpianos localizados en el semilunar, constituyen una de las condiciones patológicas más raras que puedan verse. Aquí presentamos un caso del tipo penetrante de ganglión intraóseo, localizado en el semilunar como causa poco común del dolor de muñeca. El paciente fue tratado exitosamente mediante una intervención quirúrgica. El quiste ganglionar intraóseo debe ser considerado en el diagnóstico diferencial de dolores de muñeca sordos que se han hecho sentir por mucho tiempo, y se han vuelto crónicos.

Penetrating type intraosseous ganglion cyst of the lunate bone / Ganglión intraóseo penetrante del semilunar

Intraosseous ganglion cysts of the carpal bones located in the lunate are one of the rarely seen pathologic conditions. Here we present a case of the penetrating type of intraosseous ganglion cyst located in the lunate as an uncommon cause of wrist pain. The patient was successfully treated by surgical intervention. Intraosseous ganglion cyst should be considered in the differential diagnosis of chronic dull wrist pain.

Los gangliones intraóseos de los huesos carpianos localizados en el semilunar, constituyen una de las condiciones patológicas más raras que puedan verse. Aquí presentamos un caso del tipo penetrante de ganglión intraóseo, localizado en el semilunar como causa poco común del dolor de muñeca. El paciente fue tratado exitosamente mediante una intervención quirúrgica. El quiste ganglionar intraóseo debe ser considerado en el diagnóstico diferencial de dolores de muñeca sordos que se han hecho sentir por mucho tiempo, y se han vuelto crónicos.

Sustitución del semilunar con la cabeza del hueso grande / Replacement of the lunate with the head of the capitate

A los pacientes que sufren inestabilidad del carpo a causa de una luxación inveterada y necrosis avascular del hueso semilunar, se propone realizarles un procedimiento quirúrgico que consiste en sustituir este hueso con la porción proximal o cabeza del hueso grande del carpo y el auxilio de un pequeño injerto esponjoso de la cresta ilíaca. A cinco pacientes que concurrieron a la consulta, dos con una luxación de de este hueso varias semanas y tres que padecían de necrosis avascular, se les realizó este procedimiento con excelentes resultados (AU)