[Wrist arthroscopy for fractures of the distal end of the radius]. / Artroscopía de muñieca en fracturas del extremo distal del radio.

INTRODUCTION: Fractures of the distal end of the radius are very frequent in the orthopedist's practice. The anatomical reduction of the articular surface and the extra-articular alignment of the radius are extremely important to minimize complications. The purpose of the study is to make an arthroscopic diagnosis of the lesions associated to the distal radius and assist in the reduction of the distal radius fracture. MATERIAL AND METHODS: The study was conducted from March 2007 to February 2008. We performed 20 wrist arthroscopies in 20 patients with an intraarticular fracture of the distal end of the radius. They were classified according to Frykman's criteria. Patient age ranged from 17 to 67, with a mean of 38.7 +/- 15.9 years. 60% were males and 40% females; mean follow-up was 12 months; the chondral lesions were classified according to Outerbridge, the interosseous ligament lesions and the triangular fibrocartilage lesions, according to Palmer's criteria. We did articular debridement, radiofrequency chondroplasty, and assisted the fracture reduction. We used Henry's palmar approach and did open reduction and internal fixation with a T-shaped palmar plate and finally performed an arthroscopy to check the reduction. RESULTS: 8 cases had chondral lesions (grades II to IV); 7 cases had lesion of the triangular fibrocartilage (central isolated ruptures, radial detachment of the triangular fibrocartilage from the sigmoid notch), 5 cases had lesion of the scapholunate ligament; one case had a lesion of the luno-pyramidal ligament, and in 6 cases no associated lesions were found; 8 cases had a single lesion and 6 cases had 2 to 3 concomitant lesions. Two patients had been lost at the 3- and 6-month follow-up visits; 35% of those that were followed-up had pain at 3 months (7 patients) and 15% at 6 months. Only 2 cases had scapholunate instability and only one case had distal radioulnar instability. CONCLUSIONS: Arthroscopy has proven useful in identifying hidden lesions, assisting in fracture reduction and even treating the lesions found at the time of the diagnosis. Chondral lesions were the most frequent ones, followed by lesions of the triangular fibrocartilage; a close relation was found between the type of Frykman fracture and the associated lesion. Type 7 and 8 lesions were more frequently associated with chondral lesions and with a higher mean age. At the end of the follow-up period the scapholunate ligament lesions remained unstable. Chondral lesions were related with persistent pain at 3 months.

[Vertebral destruction syndrome. Diagnostic evaluation systems]. / Síndrome de destrucción vertebral. Sistemas de evaluación en su diagnóstico.

BACKGROUND: Vertebral Destruction Syndrome (VDS) is a pathology of multiple etiologies causing structural alterations of the spine, producing deformity with neurological and mechanical alterations. In order to study VDS, a diagnostic process is carried out, sometimes with unexpected results. We undertook this study to validate the systematization of a series of studies to arrive at the diagnosis of VDS. METHODS: We included 105 patients in the study with diagnosis of VDS from January 1998 to December 2005, taking into consideration specificity, sensitivity and predictive value of each integrated study in order to determine its diagnostic value. RESULTS: The most frequent etiology was Pott's Disease (24 cases) followed by osteomyelitis (20 cases), metastasis (18 cases) and multiple myeloma and plasmacytoma (16 cases each). The higher sensitivity in Pott's Disease was obtained with bone scan and polymerase chain reaction (PCR); for multiple myeloma, computerized axial tomography (CAT) and bone scan; CAT and bone scan for infections; MRI for primary tumors; and MRI and bone scan for secondary tumors. CONCLUSIONS: To reduce false positives to 2% and to reduce the maximum number of false negatives, studies such as CAT, MRI, bone scan, PCR, ESR, C-reactive protein and determination of alkaline and acid phosphatase must be included in the VDS study protocol. Other studies have very low diagnostic sensitivity and specificity.

Síndrome de destrucción vertebral: sistemas de evaluación en su diagnóstico / Vertebral destruction syndrome: diagnostic evaluation systems

BACKGROUND: Vertebral Destruction Syndrome (VDS) is a pathology of multiple etiologies causing structural alterations of the spine, producing deformity with neurological and mechanical alterations. In order to study VDS, a diagnostic process is carried out, sometimes with unexpected results. We undertook this study to validate the systematization of a series of studies to arrive at the diagnosis of VDS. METHODS: We included 105 patients in the study with diagnosis of VDS from January 1998 to December 2005, taking into consideration specificity, sensitivity and predictive value of each integrated study in order to determine its diagnostic value. RESULTS: The most frequent etiology was Pott's Disease (24 cases) followed by osteomyelitis (20 cases), metastasis (18 cases) and multiple myeloma and plasmacytoma (16 cases each). The higher sensitivity in Pott's Disease was obtained with bone scan and polymerase chain reaction (PCR); for multiple myeloma, computerized axial tomography (CAT) and bone scan; CAT and bone scan for infections; MRI for primary tumors; and MRI and bone scan for secondary tumors. CONCLUSIONS: To reduce false positives to 2% and to reduce the maximum number of false negatives, studies such as CAT, MRI, bone scan, PCR, ESR, C-reactive protein and determination of alkaline and acid phosphatase must be included in the VDS study protocol. Other studies have very low diagnostic sensitivity and specificity.