Complicaciones a mediano plazo de la prótesis monopolar modular de cabeza radial / Mid-term complications of the monopolar, modular radial head prosthesis

Resumen: Introducción: El objetivo de este estudio es evaluar el tipo, la frecuencia y la gravedad de las complicaciones después de la implantación de la prótesis monopolar modular de cabeza radial. Material y métodos: Se revisaron retrospectivamente 47 pacientes con 48 prótesis de cabeza radial implantadas entre 2009 y 2017 durante una media de 43.55 meses (rango: 12-89). Resultados: Se implantó el mismo tipo de prótesis en cada paciente (Ascension Modular Radial Head) . La puntuación media obtenida en la clasificación Mayo Elbow Performance Score fue de 88.29 ± 9.9 puntos. Durante el seguimiento tres pacientes (6.25%) sufrieron dolor continuo. Doce casos (25.5%) mostraron sobredimensión radiológica, aunque sólo cinco fueron sintomáticos. Se detectó osificación heterotópica en 27 casos (57.4%), 11 pacientes (23.4%) desarrollaron rigidez postoperatoria, 19 casos (40.42%) mostraron osteólisis periprotésica, de los cuales siete fueron sintomáticos, 13 pacientes (27%) presentaron complicaciones: tres casos de infección, cuatro casos de aflojamiento sintomático, dos neuroapraxias, una inestabilidad y tres casos de sobredimensionamiento con rigidez asociada. Nueve pacientes (18.75%) fueron reintervenidos. Discusión: Presentamos 27% de complicaciones globales, principalmente relacionadas con la sobredimensión y el aflojamiento protésico y 19% de reintervenciones. Estos resultados son similares a los descritos en estudios previos con variaciones en función del tiempo de seguimiento. Asimismo, se requieren nuevos estudios para evaluar los resultados a largo plazo y la posible progresión de los hallazgos radiográficos. Conclusión: En conjunto, estos datos ponen de manifiesto la necesidad de mejoría tanto de la técnica quirúrgica como del diseño de los implantes.

Abstract: Introduction: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. Material and methods: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). Results: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. Discussion: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. Conclusion: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.

Prevalencia de mano zamba radial en Hospital Shriners-México y revisión de la literatura / Radial club hand prevalence at Shriners Hospital-Mexico and literature review

Resumen: Introducción: La mano zamba radial congénita se caracteriza por la desviación radial de la mano como resultado de hipoplasia o ausencia del radio. Material y métodos: Se realizó un estudio descriptivo, retrospectivo, transversal y observacional de los pacientes activos con diagnóstico de mano zamba radial. Resultados: Se estudiaron 71 pacientes y 92 extremidades, la prevalencia en nuestro hospital fue de 0.08%, 64.7% fueron hombres y 35.3% mujeres. Se observaron 22 pacientes con afectación de la extremidad torácica derecha, 28 de la izquierda y 21 pacientes bilateral. Se encontró que 93% de los pacientes presentaban un síndrome asociado. El tipo de displasia longitudinal radial más común fue la tipo I. Cincuenta y ocho extremidades no contaban con pulgar. El Estado de México es el más afectado y 91.6% contaban con un responsable tutelar con escolaridad máxima de preparatoria.

Abstract: Introduction: Radial club hand is characterized by radial deviation of the hand, as a result of hypoplasia or absence of the radius. Material and methods: A descriptive, retrospective, cross-sectional and observational study of active patients diagnosed with radial club hand at the Shriners-Mexico Hospital was carried out. Results: We studied 71 patients and 92 limbs, the prevalence was 0.08%, 64.7% were men and 35.3% women. We observed 22 patients with involvement of the right thoracic extremity, 28 left and 21 bilateral. It was found that 93% of the patients had an associated syndrome. The most common type of radial longitudinal dysplasia was type 1. 58 limbs did not have a thumb. The State of Mexico is the most affected and 91.6% had a guardian with maximum high school education.

Luxación congénita de cabeza radial: reporte de dos casos / Congenital radial Head dislocation: report of two cases

Resumen: Introducción: La luxación congénita de cabeza radial es un padecimiento que se ha descrito en contados casos en la literatura internacional, siendo la luxación anterior y lateral las formas de presentación menos frecuentes con 15% de los casos cada una y la luxación posterior la más frecuente con 70% del total de los casos reportados. Sin embargo, esta patología es considerada la patología congénita más frecuente del codo en el niño. Se presenta el caso de un paciente con luxación congénita de codo variedad anterior y otro caso con luxación variedad lateral, ambos diagnosticados a temprana edad, en los que se decidió realizar un manejo conservador y un seguimiento anual. Asimismo, se hizo una revisión bibliográfica del tema. Discusión: La luxación congénita de codo tiene por lo general una evolución benigna, siendo indolora y poco limitante para el paciente, por lo que puede ser manejada de manera conservadora. El dolor y la limitación de movimientos son indicativos de un tratamiento quirúrgico; sin embargo, no son ampliamente aceptados debido a las complicaciones y resultados deficientes que presentan.

Abstract: Introduction: Congenital dislocation of the Radial head is a condition that has been described in a few cases in the international literature, the anterior and lateral dislocation were the less frequent forms of presentation with 15% of cases, each, and the posterior dislocation the most frequent with 70% of the total cases reported. However, this pathology is considered the most frequent congenital pathology of the elbow in children. The present study describes the case of a patient with congenital dislocation of elbow anterior variety and another case with dislocation lateral variety, both diagnosed at an early age, in which it has been decided for conservative management and an annual follow-up. A bibliographic review of the subject is also carried out. Discussion: The congenital elbow dislocation usually has a benign evolution, being painless and not very limiting for the patient, so it can be managed conservatively. Pain and limited movement are indicative of surgical treatment. There are multiple surgical treatments for this entity, however they are not widely accepted due to the complications and poor results presented by them.

Luxación anterior aislada e irreductible de la cúpula radial en un paciente pediátrico: un raro reporte de caso / Isolated irreducible anterior radial head dislocation in a child: a rare case report

La luxación de la cabeza radial suele asociarse a fractura o deformidad plástica cubital. La luxación aislada es rara. Sin tratamiento, puede evolucionar hacia deformidad cubital en valgo, lesión nerviosa, artrosis precoz y pérdida del rango de movilidad con limitación funcional. Se presenta a un paciente de 9 años que sufrió traumatismo de codo. Acudió a nuestra Institución a los 40 días y se diagnosticó luxación irreductible de la cabeza radial, primero desapercibida. La luxación era irreductible por un ojal en el ligamento anular y requirió ser reducida a cielo abierto. En ausencia de fractura, incluso sin evidencia de deformidad plástica del cúbito, debe sospecharse la luxación de la cabeza radial. La clínica, junto con el par radiográfico bilateral y el conocimiento de esta entidad poco frecuente, son el trípode necesario para alcanzar el diagnóstico y no demorar el tratamiento.

Anterior radial head dislocation in pediatric population is related to Monteggia fracture-dislocations. Isolated radial head dislocation is uncommon. Sometimes, radial head dislocation becomes irreducible. This entity can develop into chronic conditions such as nerve injuries, early osteoarthritis, limited range of motion and cubitus valgus. We describe a case of a 9-year-old patient who suffered elbow trauma. He was admitted to our institution 40 days after, where radial head dislocation was diagnosed. This condition was misdiagnosed at first stage. It was irreducible due to a tear in the annular ligament. He underwent open reduction. Radial head dislocation must be suspected even if there are no fractures or plastic deformity. Pure irreducible radial head dislocation is rare. Physical examination, together with plain bilateral radiographs and full acknowledgement of this rare condition are the basis to reach early diagnosis, which leads to proper non-delayed treatment.

Deformidad de Madelung: presentación de un caso / Madelung deformity: case report

La deformidad de Madelung es una alteración poco común de la articulación de las muñecas, con una prevalencia desconocida por los pocos casos reportados hasta la actualidad. Se vincula a mutaciones del gen SHOX. Se caracteriza por presentar alteraciones en el radio, el carpo y el cúbito, con predominio bilateral. Afecta principalmente a pacientes de sexo femenino; los signos y síntomas se revelan al inicio de la adolescencia. Presentamos el caso clínico de una paciente de sexo femenino de 17 años que registra las manifestaciones clínicas y radiográficas características. (AU)

Madelung deformity is a rare alteration of the wrist joint of unknown prevalence due to the few cases reported. It has been linked to SHOX gene mutations. Madelung deformity is characterized by alterations of the radius, carpus and ulna, predominantly bilateral and mainly seen in female patients at the beginning of the adolescence. We report the clinical case of a 17-yearold female patient presenting the characteristic clinical and radiographic deformities. (AU)

Tumour of Interosseous Membrane Forearm.

25-year old female presented with swelling on dorsal aspect of proximal third of forearm with difficulty in supination and pronation. Swelling was excised and sent for histopathological examination. Biopsy report showed as - benign spindle cell tumour favouring fibromatosis. Extra adbominal fibromatosis from interosseous membrane of forearm is a rare presentation. Conclusion : Athough it is rare entity differential diagnosis should be kept in mind if there is swelling in proximal third of forearm presented with restriction of supination and pronation. Because these tumours are locally aggressive, early diagnosis and treatment are crucial to minimize morbidity.

[Intramuscular haemangioma of the forearm with radial and ulnar periosteal reaction [Report of one case]]

We present a rare case of intramuscular Haemangioma of the forearm with periosteal reaction of radius and ulna. A 38-year-old female presented with a tumefaction in distal and dorsoulnar side of the right forearm. She had 1.5 years history of tumor which was painful during resent 2 months. Plain x-ray and MRI was done and the diagnosis of Haemangioma was proved by open biopsy. The tumor plus periosteal reaction and enlarged bone was respected. After 4 years follow-up no recurrence was seen

Giant cell tumor of the lower end of the radius

Five cases of giant cell tumor of the lower end of radius are reported. Three of the patients were women and two were men, the youngest of the patients was 18 years old and oldest 37 years. En bloc resection followed by reconstructive procedures were performed in three of the cases with good results

Osteochondritis dissecans of bilateral radial heads

To our knowledge, no report of osteochondritis dissecans of radial head has been published we present a case of young boy of 14 years with osteochondritis dissecans of both radial heads

Estudo do comportamento do tecido ósseo frente ao implante do polímero de mamona em rádios de coelhos, pela análise quantitativa das radiopacidades nas imagens radiográficas convencionais / Bone radiographic study associeted to a castor beans polyrethane resin in surgical defects in rabbits: radiopacities quantitative analysis

O comportamento do tecido ósseo frente ao implante do polímero de mamona, em cirurgia experimental, em rádios de coelhos, foi estudado através de radiografias convencionais padronizadas, utilizando-se de critério de radiopacidades pré-estabelecidas para estruturas anatômicas presentes nas áreas de interesse das imagens, obtidas dos defeitos ósseos induzidos controle (com coágulo sanguíneo) e teste (com polímero de mamona) nos períodos de 15, 30, 90 e 120 dias. Os resultados mostraram a intensificaçäo das radiopacidades nas áreas dos defeitos controle em todos os períodos e em relaçäo ao polímero de mamona, a evoluçäo e/ou retardo no processo de reparo ósseo, a relativa constância de radiopacidade do polímero e seus excessos superficiais adaptados ao leito receptor e as mudanças de radiopaciadde nas regiöes de interface polímero-osso. Pela análise quantitativa de radiopacidade proposta, pode-se concluir que as radiografias convencionais padronizadas e com qualidade säo excelentes meios para investigaçäo näo invasiva do comportamento biológico do tecido ósseo e o critério pré-estabelecido, sistematiza e confere reproditibilidade aos estudos radiográficos do processo de reparo ósseo e das relaçöes de interface na pesquisa de materiais aloplásticos substitutos ósseos biocompatíveis

Evidence for a new ad sysdrome: report of a large iranin sibship with severe multiple synostosis

An investigation was carried out on a young unrelated couple, both 29 years old, with two boys and three girls, 3 months to 8 years old. One boy and the mother were healthy, the other four children and the father were affected. The family, originally from the district of Nour, in northern Iran, near the Caspian Sea, was first counseled at the Genetic Clinic in Tehran in 1984. Several trips were made to the location in a period of five years, to examine this large family. The major anomalies in this family were brachyphalangia, elbow joint aplasia [humero - radial synostosis, 110 to 140°C], carpal/tarsal synostosis and talus/calcaneus fusion. All affected individuals present a fixation of the feet in supination position and because of partial synostosis [physis] of calcaneus and talus, walked on lateral side with the external cant of the foot. All deformities were studied by clinical examinations and radiological confirmations, on each affected individual

Lipoma parosteal; relato de um caso: radiologia convencional, tomografia computadorizada e ressonância magnética / Parosteal lipoma; a case report: conventional radiology, CT and MRI

Relato de caso de lipoma parosteal, tumor benigno raro, associado com exostose, localizado na porçäo proximal do rádio. Os aspectos diagnósticos na radiologia convencional, tomografia computadorizada e ressonância magnética säo apresentados

Abordagem cirurgica do tumor de celulas gigantes da extremidade distal do radio / Surgical approach to the giant cell tumor of distal radius extremity

Os autores estudam 15 pacientes com diagnostico de tumor de celulas gigantes localizadas na extremidade distal do radio entre 1980 e 1993. A dor foi sintoma mais importante e esteve presente em todos os casos. O tratamento com resseccao marginal e metilmetacrilato, indicados no estagio 2, proporcionou bons resultados. No tratamento do estagio 3, onde esta indicada a resseccao ampla, a utilizacao do enxerto vascularizado de fibula, preservando a epifise proximal da mesma, permitiu a reconstrucao do antebraco preservando mobilidade indolor no punho.

Adamantinoma: relato de um caso / Adamantinoma: a case report

O adamantinoma, também chamado ameloblastoma, é neoplasia rara dos ossos longos (pouco mais de 100 casos descritos na literatura) e com origem näo estabelecida. Por possuir aspectos que lembram o ameloblastoma da mandíbula, é geralmente correlacionado com aquele tumor, inclusive no próprio nome. Com a finalidade de dar conhecimento à literatura, os autores apresentam um caso considerado clássico de adamantinoma e fazem breve revisäo da clínica, radiologia e patologia deste tumor