Classification of the transverse pattern of Mason II radial head fractures and its usefulness in arthroscopic osteosynthesis. Anatomo-surgical study. / Clasificación del patrón transversal de las fracturas de la cabeza del radio tipo Mason II y su utilidad en la osteosíntesis mediante técnica artroscópica. Estudio anatomoquirúrgico.

OBJECTIVE: The management of MasonII fracture pattern assisted by arthroscopy is a valid technique that provides good results. The objective of this study was to draw attention to the usefulness of the location of the fracture in the head of the radius in defined quadrants with respect to the bicipital tuberosity through CT. This would help to plan the optimal forearm position to access each quadrant and foresee the specific difficulties of each one. MATERIAL AND METHOD: We dissected 4 specimens of cryopreserved cadaver. We divided the radial head into 4 quadrants with regard to the bicipital tuberosity, objectifying the change of position in pronation and maximum supination with respect to the sigmoid cavity and neurovascular structures. RESULTS: The head of the radio moves with pronosupination, so there are areas of convergence between the different quadrants. Quadrant1 is approached in supination via an anteromedial portal. Quadrant2 is approached in maximum pronation through a lateral portal. Quadrant3 can be approached through lateral portals, with the forearm in neutral position and in pronation. Quadrant4 is accessible with the forearm in a neutral position and in supination through a lateral portal. CONCLUSIONS: Depending on the location of the fracture in the head of the radius with respect to the bicipital tuberosity, we will need access through a specific arthroscopic portal, with the medial quadrants (anteromedial and posteromedial) being the most technically demanding.

Long-standing pain in a 25-year-old patient with a non-diagnosed cervical osteoblastoma: a case report.

Benign osteoblastomas are infrequent tumors, representing less than 1% of all bone tumors. The spinal location accounts for 40-50% of all osteoblastomas from which only 20% are located in the cervical spine. The majority of the spinal osteoblastomas arise from the posterior elements: pedicles, laminas, transverse or spinous processes. We present a case report of a young male that due to the lack of specific symptoms was diagnosed of a cervical osteoblastoma 14 months after the first symptoms. The tumor was located in the right C7 pedicle. We then operated, resected the tumor and a posterior C6-T1 bilateral instrumentation was performed to stabilize the spine. Nowadays, this delay in diagnosis may be avoided by the routine use of MRI or CT for unspecific cervical symptoms. The treatment of this lesion is the complete surgical resection based on a correct preoperative planning with CT and MRI in order to define precisely the location, size and extension of the tumor. Currently, percutaneous or minimally invasive surgery is not commonly used in the treatment of this lesion.

Pathological femur fracture secondary to radiation therapy for soft tissue sarcoma.

Bone fracture is a well known possible late complication of radiation treatment. Little has been written about fractures of long bones after irradiation. We present a case of femur bone necrosis secondary to postoperative radiation for a soft tissue sarcoma of the thigh 20 years earlier. Fixation of the diaphyseal fracture and radiological evolution are described.

[The therapeutic posture in desmoid tumor]. / Actitud terapéutica ante el tumor desmoide.

BACKGROUND: The desmoid tumor is a histologically benign neoplasm originating in muscular-aponeurotic structures and possesses a high tendency of local recurrence. The aggressive nature of the tumor obliges radical surgery to be performed principally in extra-abdominal tumors. METHODS: Twelve patients were treated from 1983 to 1993. The treatments performed prior to and after histologic diagnosis, the time of evolution when radical treatment was carried out upon diagnosis and the evolution after treatment were evaluated. RESULTS: Of the patients with desmoid tumor 8 were males with a mean age of 29.9 +/- 12.5 years. In eleven cases the presentation was as a tumor and was of pain in only one case. All the patients were surgically treated with a total of 27 interventions being carried out. Three patients also received pharmacologic treatment with tamoxifen, in 2 cases associated to sulindac. In two radiotherapy was used but not as a first line treatment. Following a mean follow up of 38 +/- 17 months no mortality has been registered but 5 patients are not disease free. CONCLUSIONS: The therapeutic attitude to the desmoid tumor should be radical surgery in both the primary tumor and the recurrences with medical treatment being performed in specific situations.

Simultaneous subluxation of the metacarpophalangeal joints of all four fingers: a case report.

Simultaneous subluxation of the metacarpophalangeal joints of all four fingers is rare, and we have found no cases in the literature. A 45-year-old construction worker fell and dislocated the metacarpophalangeal joints of all the fingers of his left hand. Closed reduction by manipulation was successfully accomplished, and the patient returned to work within 5 months of his accident. He had a full range of motion 1 year later.