Analysis of Wrist Morphology Through Hamate and Lunate Bone Variations in Anatolian Population Using Plain Radiography / Análisis de la Morfología de la Articulación Radiocarpiana a Través de las Variaciones de los Huesos Hamato y Semilunar en la Población de Anatolia Mediante Radiografía Simple

SUMMARY: The present study aimed to evaluate wrist (lunate) anatomy in terms of the incidence of lunatum morphology on plain-radiographs among the Anatolian (Turkey) population, accompanied by demographic analysis. We obtained all the patients' data regarding demographical features, diagnosis, and posteroanterior (PA) X-ray imaging. Two radiograph-reviewers repeated the analysis twice, one month later, blinded to their findings before the previous review. The lunatum structure was determined as Type-1 (n:293) and Type-2 (n:207) for each radiograph. Most of the 500 wrists' radiographs [n:293 (58.6 %)] were type-I lunate. The mean age was 36.7±13.3 (range:18-90) years. Sex distribution was as follows: 185 (63.1 %) males to 108 (36.9 %) females. Type-2 lunate was seen in 207 participants (41.4 %). The mean age for type-2 was 41.6±15.2 (18-88) years. 142 (68.6 %) participants were male sex, while 65 (31.4 %) were females. The mean age of subjects with type-I showed a difference with type-II (p=0.007). There was no relationship in terms of sex (p=0.206) between the groups. In the Anatolian region, type-1 lunate was dominant compared to type-2. The incidence rate of lunate type in Anatolian population was similar to the Arab population.

El presente estudio tuvo como objetivo evaluar la anatomía de la articulación radiocarpiana en términos de la incidencia de la morfología del hueso semilunar en radiografías simples entre la población de Anatolia (Turquía), acompañado de un análisis demográfico. Obtuvimos todos los datos de los pacientes con respecto a las características demográficas, el diagnóstico y las imágenes de rayos X posteroanteriores (PA). Dos revisores de radiografías repitieron el análisis dos veces, un mes después, sin conocer sus hallazgos antes de la revisión anterior. La estructura del lunatum se determinó como Tipo-1 (n:293) y Tipo-2 (n:207) para cada radiografía. La mayoría de las 500 radiografías de muñecas [n:293 (58,6 %)] fueron semilunar tipo I. La edad media fue de 36,7±13,3 (rango: 18-90) años. La distribución por sexos fue la siguiente: 185 (63,1 %) hombres y 108 (36,9 %) mujeres. El semilunar tipo 2 se observó en 207 participantes (41,4 %). La edad media para el tipo 2 fue de 41,6±15,2 (18-88) años. 142 (68,6 %) participantes eran del sexo masculino, mientras que 65 (31,4 %) eran del sexo femenino. La edad media de los sujetos con tipo I mostró una diferencia con el tipo II (p = 0,007). No hubo relación en cuanto al sexo (p=0,206) entre los grupos. En la región de Anatolia, el semilunar tipo 1 era dominante en comparación con el tipo 2. La tasa de incidencia del tipo semilunar en la población de Anatolia fue similar a la de la población árabe.

Total Wrist Arthrodesis: A Preoperative Test to Predict Functional Outcomes / Artrodese total do punho: Um teste pré-operatório para prever resultados funcionais

Abstract Objective The study aims to demonstrate an evaluation method to predict the functional success of total wrist arthrodesis (TWA) and assist its indication. Methods A prospective study including ten patients submitted to (TWA) posttraumatic arthritis. Exclusion criteria were patients who lost postoperative follow-up or incomplete information in the medical record. The objective functional assessment (handgrip strength, three-point pinch, lateral pinch and pulp-pulp pinch) and the subjective functional assessment (DASH, PRWE, EVA) were evaluated in 3 different periods: (1) Before surgery without articular anesthesia, (2) Before surgery under articular anesthesia and (3) 12 weeks after the surgical procedure. Results There was an increase in handgrip strength in all three pinches measurements after pain relief, both after joint anesthesia and after the consolidation of the arthrodesis (p < 0.05). In the comparisons between the subjective evaluations (DASH, PRWE and VAS), the patients had better scores in the postoperative evaluation after 12 weeks (p < 0.05). There was no statistical difference when comparing the mean strength values found after anesthesia and after 12 weeks of TWA. Conclusion the outcomes could propose an assessment protocol for patients with indication for TWA, in which patients with good response to intra-articular anesthetic infiltration would benefit from the effects of the surgical procedure.

Resumo Objetivo O estudo tem como objetivo demonstrar um método de avaliação para predizer o sucesso funcional da artrodese total do punho (ATP) e auxiliar na sua indicação. Métodos Um estudo prospectivo incluindo dez pacientes submetidos a ATP por artrite pós-traumática. Os critérios de exclusão foram pacientes que perderam o acompanhamento pós-operatório ou informações incompletas no prontuário. A avaliação funcional objetiva (força de preensão manual, pinça de três pontos, pinça lateral e pinça polpa-a-polpa) e a avaliação funcional subjetiva (DASH, PRWE, EVA) foram avaliadas em 3 momentos diferentes: (1) Antes da cirurgia sem anestesia articular, (2) Antes da cirurgia sob anestesia articular e (3) 12 semanas após o procedimento cirúrgico. Resultados Houve aumento da força de preensão palmar nas três medidas de pinça após o alívio da dor, tanto após a anestesia articular quanto após a consolidação da artrodese (p < 0,05). Nas comparações entre as avaliações subjetivas (DASH, PRWE e VAS), os pacientes tiveram melhores escores na avaliação pós-operatória após 12 semanas (p < 0,05). Não houve diferença estatística ao comparar os valores médios de força encontrados após a anestesia e após 12 semanas de ATP.

The analysis of the therapeutic effect for 10 cases of type C extreme distal radial fracture in micro needle plate internal fixation / 中国骨伤

OBJECTIVE@#To analyze the clinical outcomes of mini-plate combined with wireforms in the treatment of Type C distal radial fractures with marginal articular fragments.@*METHODS@#This retrospective study included a total of 10 cases, including 5 males and 5 females, with 6 cases involving the left side and 4 cases involving the right side, of Type C distal radial fractures with marginal articular fragments. The age of the patients ranged from 35 to 67 years old. All patients underwent surgical treatment utilizing mini-plate combined with wireforms for internal fixation.@*RESULTS@#The follow-up period ranged from 6 to 18 months. Complete fracture healing was observed in all cases, with healing times ranging from 10 to 16 weeks. During the entire follow-up period, patients reported high levels of satisfaction with the treatment outcomes, and there were no incidences of incision infection, chronic wrist pain, or wrist traumatic arthritis. At the final follow-up assessment, the Mayo score for the wrist joint ranged from 85 to 95, with 7 cases rated as excellent and 3 cases as good.@*CONCLUSION@#Mini-plate combined with wireforms proves to be an effective fixation method for Type C distal radial fractures with marginal articular fragments. The early initiation of wrist joint exercises, strong fixation, maintenance of proper reduction, minimal complications, and high rates of excellent and good outcomes demonstrate the reliability and efficacy of this treatment approach.

Double-column Die-punch fractures of distal radius treated with butterfly plate fixation via Henry approach / 中国骨伤

OBJECTIVE@#To explore clinical effect of open reduction and internal fixation with Henry's approach butterfly plate in treating double-column Die-punch fractures of distal radius.@*METHODS@#From January 2018 to June 2021, 26 patients with double-column Die-column distal radius were treated with open reduction and internal fixation through Henry's surgical approach and using distal radius volar column plate(butterfly plate), including 14 males and 12 females, aged from 20 to 75 years old with an average age of (44.2±3.4) years old. Postopertaive complications were observed, Gartland-Werley score at 12 months after opertaion was used to evaluate wrist joint function.@*RESULTS@#All 26 patients were followed up from 10 to 18 months with an average of(13.4±0.8) months. All fractures were obtained fracture union, the time ranged from 8.5 to 15.8 weeks with an average of (11.4±0.5) weeks. All incisions healed at stageⅠwithout infection, nerve injury and internal fixation failure occurred. Postoperative Gartland-Werley score at 12 months was (3.65±0.36), and 16 patients got excellent result, 8 good and 2 moderate.@*CONCLUSION@#Open reduction and internal fixation with butterfly plate for the treatment of double-column Die-punch fractures of the distal radius through volar Henry approach could obtain satisfactory clinical outcomes.

Three-dimensional finite element model construction and biomechanical analysis of customized titanium alloy lunate prosthesis / 中国修复重建外科杂志

OBJECTIVE@#To design customized titanium alloy lunate prosthesis, construct three-dimensional finite element model of wrist joint before and after replacement by finite element analysis, and observe the biomechanical changes of wrist joint after replacement, providing biomechanical basis for clinical application of prosthesis.@*METHODS@#One fresh frozen human forearm was collected, and the maximum range of motions in flexion, extension, ulnar deviation, and radialis deviation tested by cortex motion capture system were 48.42°, 38.04°, 35.68°, and 26.41°, respectively. The wrist joint data was obtained by CT scan and imported into Mimics21.0 software and Magics21.0 software to construct a wrist joint three-dimensional model and design customized titanium alloy lunate prosthesis. Then Geomagic Studio 2017 software and Solidworks 2017 software were used to construct the three-dimensional finite element models of a normal wrist joint (normal model) and a wrist joint with lunate prosthesis after replacement (replacement model). The stress distribution and deformation of the wrist joint before and after replacement were analyzed for flexion at and 15°, 30°, 48.42°, extension at 15°, 30°, and 38.04°, ulnar deviation at 10°, 20°, and 35.68°, and radial deviation at 5°, 15°, and 26.41° by the ANSYS 17.0 finite element analysis software. And the stress distribution of lunate bone and lunate prosthesis were also observed.@*RESULTS@#The three-dimensional finite element models of wrist joint before and after replacement were successfully constructed. At different range of motion of flexion, extension, ulnar deviation, and radial deviation, there were some differences in the number of nodes and units in the grid models. In the four directions of flexion, extension, ulnar deviation, and radial deviation, the maximum deformation of wrist joint in normal model and replacement model occurred in the radial side, and the values increased gradually with the increase of the range of motion. The maximum stress of the wrist joint increased gradually with the increase of the range of motion, and at maximum range of motion, the stress was concentrated on the proximal radius, showing an overall trend of moving from the radial wrist to the proximal radius. The maximum stress of normal lunate bone increased gradually with the increase of range of motion in different directions, and the stress position also changed. The maximum stress of lunate prosthesis was concentrated on the ulnar side of the prosthesis, which increased gradually with the increase of the range of motion in flexion, and decreased gradually with the increase of the range of motion in extension, ulnar deviation, and radialis deviation. The stress on prosthesis increased significantly when compared with that on normal lunate bone.@*CONCLUSION@#The customized titanium alloy lunate prosthesis does not change the wrist joint load transfer mode, which provided data support for the clinical application of the prosthesis.

Clinical analysis of distal radius core decompression for chronic wrist pain / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of distal radius core decompression in the treatment of chronic wrist pain caused by various etiologies.@*METHODS@#A retrospective analysis was performed for the clinical data of 10 patients with chronic wrist pain treated with distal radial core decompression between January 2018 and December 2021. There were 6 males and 4 females with an average age of 37.4 years (range, 21-55 years). The disease duration ranged from 7 to 72 months, with an average of 26.5 months. Preoperative MRI examination showed that 10 cases had bone marrow edema at the distal radius on the affected side, and 8 cases had bone marrow edema in the carpal bones such as scaphoid and lunate bone. Among them, 3 patients had a history of wrist fracture, and 2 patients had Kienböck diseases (1 case each in stage ⅡB and stage ⅢA). Three cases were combined with triangular fibrocartilage complex (TFCC) type 1A injury. Two cases were combined with osteoarthritis, 1 of them was complicated with severe traumatic arthritis, the wrist arthroscopy showed that the TFCC was completely lost and could not be repaired, and the cartilage of the lunate bone and the ulnar head were severely worn.Visual analogue scale (VAS) score was used to evaluate the relief of wrist pain before operation, at 6 months after operation, and at last follow-up, and the range of motion of the affected wrist in dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was measured. The degree of bone marrow edema was evaluated according to T1WI, T2WI, and STIR sequences of MRI.@*RESULTS@#All the patients were followed up 12-22 months, with an average of 16.4 months. Except for 1 patient who experienced persistent wrist joint pain and limited mobility after operation, the remaining 9 patients showed significant improvement in pain symptoms and wrist joint mobility. The VAS score and range of motion of wrist dorsiflexion, palmar flexion, ulnar deviation, and radial deviation at 6 months after operation and at last follow-up were significantly improved when compared with those before operation, the VAS score and the range of motion of wrist ulnar deviation and radial deviation at last follow-up were further improved when compared with those at 6 months after operation, all showing significant differences ( P<0.05). There was no significant difference in wrist dorsiflexion and palmar flexion between at 6 months after operation and at last follow-up ( P>0.05). Bone marrow edema was improved in 6 patients on MRI at 6 months after operation, and was also improved in other patients at last follow-up.@*CONCLUSION@#For chronic wrist pain caused by a variety of causes, distal radius core decompression can directly reduce the pressure of the medullary cavity of the distal radius, improve the blood supply of the corresponding distal structure, significantly alleviate chronic wrist pain, and provide an option for clinical treatment.

Analysis of the effectiveness of sequential plate internal fixation in correction of Madelung deformity after ulnar osteotomy and shortening / 中国修复重建外科杂志

OBJECTIVE@#To investigate the effectiveness of sequential plate internal fixation in the correction of Madelung deformity after ulnar osteotomy and shortening.@*METHODS@#The clinical data of 13 patients with Madelung deformity admitted between September 2015 and July 2021 were retrospectively analyzed. There were 5 males and 8 females with an average age of 18.3 years ranging from 17 to 23 years. The disease duration ranged from 12 to 24 months, with an average of 17 months. Three cases had a clear history of trauma. All patients had external radial deviation deformity and limited movement of the ulnar deviation, and the ulnar impact pain was significant during ulnar deviation movement; 9 patients had limited wrist joint supination movement, and the supination movement was normal. In the first stage, ulnar osteotomy and shortening combined with external fixator were used to correct wrist deformity in 13 patients. After operation, bone transfer was performed 6 times per day, with adjustments made every 4 hours, which was 1 mm per day. After the osteotomy was in place, the ulnar plate internal fixation was performed to reconstruct the ulnar stability in the second stage. The Cooney wrist joint score was used to assess the pain, function, range of motion, flexion and extension range of motion, and grip strength of the wrist joint before operation and before the removal of internal fixator. The subjective feeling and appearance satisfaction of patients were recorded.@*RESULTS@#After the second-stage operation, all the 13 patients were followed up 10-22 months, with an average of 15 months. The deformity of wrist joint disappeared after operation, and the flexion, extension, and ulnar deviation were basically normal. There was no complication such as ulnar impingement sign, nonunion or infection. Wrist function, pain, and range of motion were significantly improved after operation, except for 1 patient who had no significant improvement in rotation and pain. The ulnar internal fixator was removed at 10-18 months after the second-stage operation. The scores of pain, function, range of motion, flexion and extension range of motion, and grip strength in the Cooney wrist score before removal of internal fixator significantly improved when compared with those before operation ( P<0.05). Subjective and appearance satisfaction of patients were excellent in 9 cases, good in 3 cases, and fair in 1 case.@*CONCLUSION@#Ulnar osteotomy and shortening with sequential plate internal fixation for correction of Madelung deformity, with mild postoperative pain, can effectively avoid bone nonunion, improve wrist joint function, and have significant effectiveness.

Síndromes compresivos del nervio mediano. Revisión y actualización de la bibliografía / Median nerve compression syndromes. Literature review and update

El nervio mediano desciende por el brazo y, en el codo, comienza a atravesar estructuras que pueden generar compresión, como el ligamento de Struthers, el lacertus fibrosus, el pronador redondo, el flexor superficial de los dedos. Finalmente, en la muñeca, se encuentra otro sitio de compresión producido por el ligamento transverso del carpo. Todas estas estructuras pueden provocar signos y síntomas de atrapamiento nervioso y favorecer el deterioro funcional del nervio. Nuestro objetivo es dar a conocer una actualización sobre estos sitios de atrapamiento del nervio mediano, y cómo realizar un diagnóstico preciso e indicar un trata-miento adecuado. Nivel de Evidencia: IV

The median nerve is a nervous structure that begins to cross structures at the level of the elbow that might cause compression. The Struthers ligament, lacertus fibrosus, pronator teres, and flexor digitorum superficialis are among them. Finally, the transverse carpal ligament creates another compression site in the wrist. All these structures can develop pathological signs and symptoms of nerve entrapment, which favors nerve functional degradation. Our objective is to provide an update on these median nerve entrap-ment sites, as well as information on how to establish an accurate diagnosis and provide adequate treatment. Level of Evidence: IV

Transferencia tendinosa del primer radial externo al cubital posterior: ¿mejora significativamente la corrección de la desviación radial en la muñeca reumática? / Extensor carpi radialis longus tendon transfer to extensor carpi ulnaris: Does it significantly improve the correction of radial deviation in the rheumatoid wrist?

Introducción: La artritis inflamatoria puede conducir al síndrome de caput ulnae con desviación radial de la muñeca y los meta-carpianos. El tratamiento es la artroplastia de rescate de la articulación radiocubital distal y la reubicación del tendón del extensor cubital del carpo (ECC). Sin embargo, puede ser débil para corregir la desviación. Clayton describió la transferencia del tendón del extensor radial largo del carpo (ERLC) al ECC. El objetivo de este estudio fue comparar la corrección de la desviación radial de los metacarpianos en pacientes operados con transferencia del ERLC al ECC o sin ella. Materiales y Métodos: Estudio de cohorte retrospectiva en pacientes con artritis reumatoide y síndrome de caput ulnae, sometidos a tenoplastia del ECC con ERLC o sin este procedimiento. Se formaron dos grupos: pacientes con transferencia (grupo A) y sin transferencia (grupo B). Se calculó la corrección del ángulo de Clayton comparando las medidas preoperatoria y del último control, y se compararon los resultados. Resultados: El seguimiento promedio fue de 28 meses. El ángulo de Clayton preoperatorio promedio era de 44,54° (DE ± 7,52) en el grupo A y 60,24° (DE ± 12,28) en el grupo B (p = 0,001). El promedio de corrección fue de 6,57° (DE ± 4,11) y 0,95° (DE ± 9,17), respectivamente (p = 0,026). Conclusiones: El nivel de corrección fue mayor en el grupo A. No obstante, si bien ambas técnicas lograron mejorar el ángulo, el grado de corrección podría estar supeditado a la magnitud del ángulo preoperatorio. Nivel de Evidencia: IV

Introduction: Inflammatory arthritis can lead to caput ulnae syndrome with radial deviation of the wrist and metacarpals. Treatment includes salvage arthroplasty of the distal radioulnar joint and relocation of the extensor carpi ulnaris (ECU) tendon. However, the ECU may be too weak to correct the deviation. To strengthen the ECU, Clayton described the transfer of the extensor carpi radialis longus (ECRL) tendon to the ECU. The aim of this work is to compare the correction of the radial deviation of the metacarpals in patients with and without transfer of the ECRL to the ECU. Materials and Methods: Retrospective cohort study. Patients with rheumatoid arthritis and caput ulnae syndrome, treated with ECU tenoplasty with or without ECRL, were included. The patients were divided into two groups: ECRL to ECU transfer (group A) and no transfer (Group B). The correction of the metacarpal-radial angle (Clayton's angle) was calculated by comparing the measurements before surgery and at end of follow-up, and the results obtained were compared. Results: The average follow-up was 28 months. The preoperative Clayton angle was on average 44.54° (SD ± 7.52) in group A and 60.24° (SD ± 12.28) in group B (p = 0.001). The correction average was 6.57° (SD ± 4.11) and 0.95° (SD ± 9.17) for group A and B respectively (p=0.026). Conclusions: The level of correction obtained was higher in group A. However, although both techniques managed to improve the angle, the degree of correction could be subject to the magnitude of the preoperative angle. Level of Evidence: IV

Use of the Triquetrum-Hamate Portal in FourCorner Wrist Fusion: A Useful Technical Trick / Uso do portal piramidal-hamato na fusão de punho de quatro cantos: Um bom truque técnico

Abstract Arthroscopy-assisted partial wrist-fusion techniques are becoming more popular nowadays. It became clearer that avoiding the violation of important ligament and tendinous structures - which is impossible when using the classic open techniques - enables a more biological approach, which is essential for faster healing and improvement in function. We describe the use of the triquetrum-hamate (TH) portal, which is seldomly applied in routine arthroscopic techniques for hand and wrist surgery, as an accessory portal to better perform anterior midcarpal debridement in four-corner fusion. This trick enables an almost complete anterior resection of the capitate and hamate chondral surfaces, increasing the subchondral osseous contact in the midcarpal joint after fixation, thus leading to higher consolidation rates.

Resumo As técnicas de fusão parcial do punho assistidas por artroscopia estão se tornando mais populares. Ficou claro que evitar a violação de importantes estruturas ligamentares e tendíneas, o que é imposssível com as técnicas abertas clássicas, permite uma abordagem mais biológica, essencial para a cicatrização mais rápida e melhora da função. Descrevemos o uso do portal piramidal-hamato (PH), raramente aplicado em técnicas artroscópicas de rotina para cirurgia de mão e punho, como portal acessório para melhor execução do desbridamento carpal medial anterior na fusão de quatro cantos. Esse truque possibilita a ressecção anterior quase completa das superfícies condrais do capitato e do hamato, o que aumenta o contato ósseo subcondral na articulação mesocárpica após a fixação e eleva as taxas de consolidação.

Three-dimensional analysis of the gap space under forearm casts / 中华创伤杂志(英文版)

PURPOSE@#Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.@*METHODS@#This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05.@*RESULTS@#In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.@*CONCLUSION@#This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

Computed tomography medical image analysis of basketball players' bone geometry / Análise de imagens médicas por tomografia computadorizada da geometria óssea de jogadores de basquete / Análisis de imágenes médicas por tomografía computarizada de la geometría ósea de jugadores de baloncesto

ABSTRACT Introduction: Basketball sports will effect on the morphology and structure of the hand bones and joints. Objective: The article selected nine professional basketball players (basketball group) and 11 non-basketball players (control group) in the provincial youth team. A 64-row spiral computed tomography scan was used to scan the wrist and three-dimensional reconstruction. The volume of each carpal bone and the computed tomography value (bone density) were measured. Methods: To explore the influence of basketball sports on the hand bones and joints' morphological structure, the paper analyzes the structural characteristics of the computed tomography images of young male basketball players' wrist bones. Results: Compared with the carpal bones in the control group, the volume of the right navicular bone and the small polygonal bone, the left-hand navicular bone, the large triangular bone, and the small polygonal bone in the basketball group increased significantly (P<0.05). Conclusions: Basketball can increase the volume of the part of the wrist bones of adolescent male athletes and reduce the bone density; the morphological structure of the non-smashing wrist bones of basketball players has similar changes to that of the spikers. Level of evidence II; Therapeutic studies - investigation of treatment results.

RESUMO Introdução: O basquetebol afetará a morfologia e a estrutura dos ossos e articulações da mão. Objetivo: o artigo selecionou nove jogadores profissionais de basquete (grupo de basquete) e 11 não jogadores de basquete (grupo de controle) da equipe juvenil da província. Uma tomografia computadorizada espiral de 64 linhas foi usada para digitalizar o punho e a reconstrução tridimensional. O volume de cada osso do carpo e o valor da tomografia computadorizada (densidade óssea) foram medidos. Métodos: Para explorar a influência dos esportes de basquete sobre os ossos da mão e a estrutura morfológica das articulações, o artigo analisa as características estruturais das imagens de tomografia computadorizada de ossos do punho de jovens jogadores de basquete do sexo masculino. Resultados: Em comparação com os ossos do carpo no grupo de controle, o volume do osso navicular direito e o osso poligonal pequeno, o osso navicular esquerdo, o osso triangular grande e o osso poligonal pequeno no grupo de basquete aumentaram significativamente (P <0,05). Conclusões: O basquete pode aumentar o volume dos ossos do punho de atletas adolescentes do sexo masculino e reduzir a densidade óssea; a estrutura morfológica dos ossos do pulso que não se quebram em jogadores de basquete tem mudanças semelhantes às dos espigões. Nível de evidência II; Estudos terapêuticos- investigação dos resultados do tratamento.

RESUMEN Introducción: el baloncesto afectará la morfología y la estructura de los huesos y articulaciones de la mano. Objetivo: El artículo seleccionó nueve jugadores de baloncesto profesionales (grupo de baloncesto) y 11 jugadores no baloncesto (grupo de control) en el equipo juvenil provincial. Se utilizó una tomografía computarizada en espiral de 64 filas para escanear la muñeca y la reconstrucción tridimensional. Se midieron el volumen de cada hueso del carpo y el valor de la tomografía computarizada (densidad ósea). Métodos: Para explorar la influencia de los deportes de baloncesto en la estructura morfológica de los huesos de la mano y las articulaciones, el artículo analiza las características estructurales de las imágenes de tomografía computarizada de los huesos de la muñeca de los jóvenes jugadores de baloncesto. Resultados: En comparación con los huesos del carpo en el grupo de control, el volumen del hueso navicular derecho y el hueso poligonal pequeño, el hueso navicular izquierdo, el hueso triangular grande y el hueso poligonal pequeño en el grupo de baloncesto aumentaron significativamente (P <0,05). Conclusiones: El baloncesto puede aumentar el volumen de los huesos de la muñeca de los deportistas varones adolescentes y reducir la densidad ósea; la estructura morfológica de los huesos de las muñecas que no se rompen de los jugadores de baloncesto tiene cambios similares a los de los atacantes. Nivel de evidencia II; Estudios terapéuticos- investigación de los resultados del tratamiento.

Artrodesis de cuatro esquinas: análisis comparativo de técnica abierta versus técnica percutánea con asistencia artroscópica / Four-corner arthrodesis: comparative analysis of open surgery versus percutaneous technique with arthroscopic assistance

INTRODUCCIÓN: La artrodesis de cuatro esquinas es una técnica de salvataje para los pacientes con artrosis avanzada del carpo. Los objetivos quirúrgicos son disminuir el dolor y mantener cierto movimiento de la muñeca. En el último tiempo, se han descrito técnicas percutáneas con asistencia artroscópica que han logrado resultados favorables, a pesar de que la técnica abierta sigue siendo el gold estándar para realizar esa técnica quirúrgica. OBJETIVO: Comparar resultados funcionales y radiológicos en pacientes con muñecas con colapso avanzado escafolunar (scapholunate advanced collapse, SLAC) o colapso avanzado en la pseudoartrosis del escafoides (scaphoid nonunion advanced collapse, SNAC) operados con técnica quirúrgica abierta versus técnica percutánea con asistencia artroscópica. MATERIALES Y MÉTODOS: Estudio retrospectivo tipo caso-control, de fichas clínicas e imagenología de pacientes con artrosis avanzada del carpo operados con técnica percutánea y asistencia artroscópica y cirugía abierta. Se estudian variables demográficas, dolor mediante la Escala Visual Analógica (EVA), función en rangos de movilidad, tiempo de consolidación, y corrección del ángulo capitolunar. Se describe la técnica quirúrgica de la cirugía abierta y la cirugía percutánea con asistencia artroscópica. RESULTADOS: Se estudiaron 22 pacientes del sexo masculino con edad promedio de 32,5 años. Había 13 pacientes en el grupo de casos (técnica percutánea con asistencia artroscópica) y 9 pacientes en el grupo de controles (técnica abierta). El dolor en la EVA al momento del egreso hospitalario fue de 3 para los casos y de 5 para los controles (p » 0,008), y a los 30 días del postoperatorio, fue de 0 y 3 respectivamente (p » 0,00). Los rangos de extensión y flexión fueron de 52,6° y 38,7° para los casos y de 35,7° y 32,4° para los controles (p » 0,1119 y 0,0016, respectivamente). El ángulo capitolunar fue de 10° para los controles y de 5° para los casos (p » 0,0008). El tiempo de consolidación fue de 8,8 semanas para los casos y de 12,5 semanas para los controles (p » 0,039). DISCUSIÓN: Tanto la técnica percutánea con asistencia artroscópica cuanto la cirugía abierta para realizar una artrodesis de cuatro esquinas son técnicas reproducibles y efectivas en lograr consolidación, disminución del dolor, y mantenimiento de rangos de movimiento en la muñeca. CONCLUSIÓN: En el presente trabajo se demuestran mejores promedios de los parámetros evaluados con la técnica percutánea que con la cirugía abierta; sin embargo, es necesario realizar estudios prospectivos para realizar una recomendación con respecto a la técnica quirúrgica de elección.

INTRODUCTION: Four-corner arthrodesis is a salvage technique for patients with advanced carpal osteoarthritis. This procedure aims to reduce pain and preserve wrist motion. Even though percutaneous techniques with arthroscopic assistance reportedly have favorable outcomes and the advantages of minimal invasiveness, open surgery remains the gold standard for four-corner arthrodesis. OBJECTIVE: The present study aims to compare the functional and radiological outcomes of patients with scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) submitted to open surgery versus percutaneous surgery with arthroscopic assistance. MATERIALS AND METHODS: Retrospective case-control study of clinical records and radiological images of patients with advanced carpal osteoarthritis submitted to percutaneous surgery with arthroscopic assistance versus open surgery. Demographic variables, pain score using the visual analog scale (VAS), function ranges of motion, time until consolidation, and correction of the capitolunate angle were analyzed. Both techniques are described. RESULTS: In total, 22 male patients with an average age of 32.5 years were studied, including 13 patients from the case group (percutaneous surgery with arthroscopic assistance) and 9 patients from the control group (open surgery). The VAS score for pain at discharge was of 3 for the cases and of 5 for the controls (p » 0.008); 30 days postoperatively, it was of 0 and 3 respectively (p » 0.00). The ranges of extension and flexion were of 52.6° and 38.7° for the case group, and of 35.7° and 32.4° for the control group (p » 0.119 and 0.0016 respectively). The capitolunate angle was of 10° for the controls and of 5° for the cases (p » 0.0008). The time until consolidation was of 8.8 weeks for the cases and of 12.5 weeks for the controls (p » 0.039). DISCUSSION: Both four-corner arthrodesis techniques are reproducible and effective in achieving consolidation, pain reduction and preservation of wrist motion. CONCLUSION: The present study demonstrates the superiority of the percutaneous technique with arthroscopic assistance over open surgery. Further prospective studies are required for an adequate recommendation.

Detección de tornillos prominentes en la articulación radiocarpiana mediante la proyección tangencial del escafoides dorsal / Detection of protruding screws in the radiocarpal joint using the "scaphoid skyline view"

INTRODUCCIÓN: Una de las complicaciones de la osteosíntesis retrógrada del escafoides es la protrusión del tornillo en la articulación radiocarpiana, dada la limitada visualización intraoperatoria del polo proximal del escafoides con las proyecciones tradicionales. OBJETIVO: Evaluar la capacidad de una nueva proyección radiológica, la proyección "tangencial del escafoides dorsal", o TED, para identificar tornillos prominentes radiocarpianos durante la osteosíntesis retrógrada del escafoides con tornillos canulados. MATERIALES Y MÉTODOS: Estudio cadavérico en muñecas frescas congeladas. Se introdujo en el escafoides un tornillo canulado con técnica retrógrada estándar. La proyección TED fue evaluada en 5 muñecas, con angulaciones del antebrazo de 15°, 30° y 45° para definir la mejor visualización del polo proximal del escafoides y del tornillo. Se comparó la capacidad para identificar la prominencia del tornillo en el polo proximal de la proyección TED de 30° con 5 proyecciones tradicionales de escafoides en 9 muñecas. El tornillo se posicionó a nivel de la superficie del escafoides, y luego se avanzó a intervalos de 0,5 mm bajo visualización directa por artrotomía dorsal. Tras cada intervalo, se repitieron todas las proyecciones para determinar su capacidad de detectar tornillos prominentes en el escafoides. RESULTADOS: La mejor visualización del polo proximal del escafoides se logró con la proyección TED de 30°. Al comparar la proyección TED de 30° y las tradicionales, con la TED se logró identificar tornillos prominentes a 0,8 mm promedio, seguida por la proyección posteroanterior con cubitalización y extensión a 1.3 mm (p » 0.014), con una alta precisión y correlación interobservador de estas proyecciones. CONCLUSIÓN: La proyección TED demostró ser la más sensible para detectar tornillos prominentes en la articulación radiocarpiana. Su uso rutinario podría evitar complicaciones durante la osteosíntesis.

INTRODUCTION: One of the complications of the retrograde percutaneous scaphoid fixation is the protrusion of the screw in the radiocarpal joint due to the limited intraoperative visualization of the proximal pole of the scaphoid with the traditional radiographic views. OBJETIVE: To evaluate the sensitivity of a novel radiographic view (the skyline scaphoid view, SSV) to detect screws protruding in the radiocarpal joint during the retrograde fixation of the scaphoid. MATERIALS AND METHODS: We studied nine cadaverous fresh frozen wrists. A retrograde cannulated screw was inserted in the scaphoid. To validate the SSV, 5 wrists were studied, comparing 3 forearm angulations (15°, 30° and 45°) to get the best visualization of the proximal pole and screw. We compared the ability to identify the protrusion of the screw in the proximal pole of the 30° SSV with that of 5 standard scaphoid radiographic views in 9 wrists. The screw was positioned at the level of the surface of the scaphoid, and was sequentially protruded in 0.5 mm increments, with direct visualization of its tip through a dorsal capsulotomy. After each increment, all views were repeated to determine if they were able to detect screws projecting from the scaphoid. RESULTS: The best visualization of the proximal pole of the scaphoid was found with the 30° SSV. In the comparison of the 30° SSV and the standard views, with the SSV we were able to identify the protrusion of the screws at an average of 0.8 mm, followed by the posterior-anterior view with ulnar deviation and extension at 1.3 mm (p » 0.014), with high precision and interobserver agreement regarding these views. CONCLUSION: The SSV was the most sensitive view to detect protruding screws in the proximal pole of the scaphoid. Its routine use could avoid complications during osteosynthesis.

Luxofracturas radiocarpianas: evaluación retrospectiva de una serie de casos / Radiocarpal fracture-dislocation. Retrospective evaluation of a case series

Introducción: Las luxofracturas radiocarpianas consisten en la pérdida total de contacto entre las superficies articulares de la primera fila del carpo y del radio. Se producen por traumatismos de alta energía. El objetivo de este estudio fue evaluar retrospectivamente una serie de casos para comparar la incidencia de estas lesiones, el manejo terapéutico y los resultados funcionales con la bibliografía publicada por centros de referencia en esta enfermedad. Materiales y métodos: Entre febrero de 2018 y junio de 2020, se evaluó, en forma retrospectiva, a pacientes con luxofractura radiocarpiana, clasificada en tipos I y II según Dumontier. Criterios de inclusión: hombres y mujeres >18 años con luxofractura radiocarpiana cerrada o abierta y un seguimiento mínimo de 3 meses. Se llevó a cabo un seguimiento clínico/por imágenes mediante radiografías, el cuestionario DASH, la escala de muñeca modificada de la Clínica Mayo, la escala analógica visual para dolor y el PSQ-18. Resultados: Se evaluó a 8 pacientes con 9 lesiones, y un seguimiento promedio de 8 meses. Las luxaciones eran 4 tipo I y 5 tipo II. Todos fueron operados. Según valores finales, hubo 2 resultados excelentes, 6 buenos/aceptables y uno pobre. Conclusión: El mejor método para el tratamiento definitivo es quirúrgico. La correcta clasificación y el estudio de la enfermedad tienen un rol fundamental en la toma de decisiones terapéuticas. Nivel de Evidencia: IV

Introduction: Radiocarpal fracture-dislocations consist of the total loss of contact between the articular surfaces of the first row of the carpus and the radius. They are caused by high-energy trauma. The purpose of the work is to retrospectively evaluate a series of cases to compare the incidence of these lesions, their therapeutic management and functional outcomes with the literature published by reference centers in this pathology. Materials and methods: Between February 2018 and June 2020 we retrospectively evaluated patients with radiocarpal fracture-dislocations, which were classified into groups I and II according to Dumontier. Inclusion criteria: males and females over 18 years of age with closed or open radiocarpal fracture-dislocations with a minimum follow-up of 3 months. A clinical/imaging follow-up was carried out using radiographs, the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand), Modified Mayo Wrist Score, visual analog scale (VAS) and Patient Satisfaction Questionnaire Short Form (PSQ-18). Results: Eight patients with nine lesions with an average follow-up of 8 months were evaluated. Lesions were grouped into type I (4) and type II (5). All were surgically operated. According to the final values, outcomes were excellent in two cases, good/acceptable in six, and poor in one. Conclusion: We believe that the best method for definitive treatment is surgical. The correct classification and study of the pathology will play a fundamental role in making therapeutic decisions. Level of Evidence: IV

Resultados del tratamiento de la artrosis radiocubital distal mediante el procedimiento de Sauvé Kapandji artroscópico / Distal radioulnar osteoarthritis using arthroscopic Sauvé Kapandji technique

Introducción: La artrosis radiocubital distal (ARCD) produce dolor y pérdida de fuerza en movimientos de pronosupinación con limitación funcional. Nuestro objetivo es presentar los resultados obtenidos mediante la técnica de Sauvé Kapandji (SK) de forma artroscópica. Esta técnica preserva el retináculo extensor, permite la colocación anatómica de la articulación y una rehabilitación más rápida. No hemos encontrado trabajos reportando casos sobre esta técnica.Materiales y métodos: estudiamos de forma retrospectiva a siete pacientes con ARCD, evaluando el Dash y el score de la Clínica Mayo. Cinco pacientes masculinos y dos femeninos con test de Nakamura. Su edad promedio fue de 60.2 años. Cinco pacientes en edad laboral y dos jubilados. Todos los pacientes de esta serie fueron tratados de manera artroscópica con la técnica de Sauvé Kapandji (SK) artroscópica. Resultados: el seguimiento promedio fue de 14.7 meses. Cinco pacientes tenían antecedentes de fractura de muñeca y dos, antecedentes de lesión del complejo fibrocartílago triangular (CFCT), sin inestabilidad. Los siete pacientes tenían test de Nakamura positivo. Obtuvimos una supinación preoperatoria de 26.4° promedio y de 75° postoperatoria y una pronación de 32° preoperatoria y 85° postoperatoria. La fuerza obtenida fue del 25% prequirúrgica y 80% postquirúrgica. Obtuvimos un Dash score prequirúrgico de 88 puntos y un postquirúrgico de 6 puntos. El score de la Mayo de muñeca fue excelente en tres pacientes y bueno en cuatro. Obtuvimos una VAS de 9.5 en el prequirúrgico y una VAS de 1 punto al final del seguimiento. Todos los pacientes estaban conformes con las incisiones realizadas.Discusión: el procedimiento de SK es de elección en la artrosis radiocubital distal y puede realizarse en pacientes jóvenes con alta demanda cuando se presentan rupturas del CFCT sin inestabilidad, restaurando la movilidad de la muñeca, la estabilidad y la fuerza de grip. La técnica artroscópica permite la preservación del quinto y sexto compartimento, facilitando una posición anatómica de la ARCD, una rehabilitación rápida y una mejor cosmética que la cirugía convencional.Conclusión: las técnicas artroscópicas del procedimiento de SK dan resultados similares a las abiertas a largo plazo, con una movilidad y fuerza aceptables, sin embargo, la técnica con asistencia artroscópica permite no abrir los compartimientos extensores, lo que facilita una recuperación funcional más rápida y aceptable y admite evaluar la cantidad justa necesaria de resección del cartílago articular y tratar las lesiones asociadas mediante esta técnica. Nivel de Evidencia: IV

Introduction: Distal radioulnar osteoarthritis (ARCD) produces pain and loss of strength in pronosupination movements with functional limitation. Our objective is to present the results obtained using the Sauvé Kapandji (SK) technique in an arthroscopic way. This technique preserves the extensor retinaculum, allows for faster anatomical placement of the joint and rehabilitation. We have not found works reporting cases on this technique.Materials and methods: we retrospectively studied seven patients with ARCD, evaluating the Dash and the Mayo score. Five male and two female using the Nakamura test. The age of the patients was 60.2 years on average. Five patients of working age and two retirees. All patients in this series were treated arthroscopically with the arthroscopic Sauvé Kapandji technique.Results: the average follow-up was 14.7 months. Five patients had a history of wrist fracture and two had a history of Triangular Fibrocartilage Complex (CFCT) injury without instability. All seven patients had a positive Nakamura test. We obtained an average pre-operative supination of 26.4° and an average of 75° post-operatively, and a 32° pre-operative and 85° post-operative pronation. The strength obtained was 25% pre-surgical and 80% post-surgical. We obtained a pre-surgical Dash score of 88 points and a post-surgical score of 6 points. The Mayo score of the wrist was excellent in three patients, good in four. We obtained a VAS of 9.5 in the pre-surgical period and a VAS of 1 point. All patients were compliant with the incisions made.Discussion: the SK procedure is of choice in distal radioulnar osteoarthritis and can be performed in the presence of TCCC ruptures without instability in young patients with high demand, restoring wrist mobility, stability, and grip strength. The arthroscopic technique allows the preservation of the fifth and sixth compartments, allowing an anatomical position of the ARCD, with a quick rehabilitation and a better cosmetic than conventional surgery.Conclusion: the arthroscopic techniques of the KS procedure give results similar to the open ones in the long term, with acceptable mobility and strength, however, the arthroscopic-assisted technique allows not to open the extensor compartments, allowing a faster, acceptable functional recovery and allows to evaluate the necessary amount of articular cartilage resection and to treat associated injuries using this technique. Level of Evidence: IV

Resultados del tratamiento artroscópico de lesiones del complejo fibrocartílago triangular en lesiones Palmer 1D mediante anclaje óseo sin nudo / Arthroscopic treatment of triangular fibrocartilage complex injuries with bone anchor without knot

Introducción: El complejo fibrocartílago triangular (CFCT) mantiene la estabilidad de la articulación radiocubital distal (ARCD). El CFCT radial esta irrigado por la arteria interósea anterior. Una lesión radial con inestabilidad radiocubital distal debe reparase, al igual que una lesión central, para que no continúe hacia los ligamentos generando inestabilidad.Materiales y métodos: se desarrolló un estudio retrospectivo para analizar las cirugías realizadas en pacientes con lesiones del CFCT radiales Palmer 1D. Se estudiaron once pacientes masculinos de 32.8 años promedio. Todos los pacientes eran trabajadores de fuerza y el 72.7%, deportistas. El seguimiento promedio fue de 18.4 meses.Resultados: fueron evaluados once pacientes. El 63.6% de manos hábiles. El 100% de ellos presentó una lesión 1D de Palmer. La escala visual analógica del dolor preoperatorio era de 8 y postoperatoria fue de 1. El Dash score fue de 85.8 preoperatorio y de 1.18 en el postoperatorio. El score de Mayo de muñeca fue excelente en seis pacientes y bueno en cinco.Conclusión: los ligamentos radiocubitales volares y dorsales son fundamentales para mantener una adecuada estabilidad radiocubital distal ya que poseen una irrigación adecuada que permite su reparación, por lo que su reanclaje está indicado. La técnica artroscópica sin realizar túnel, expuesta en este trabajo, permite un reanclaje del CFCT sin manejos complejos con muy buenos resultados en la mayoría de los casos. Nivel de Evidencia: IV

Introduction: The triangular fibrocartilage complex (CFCT) maintains the stability of the distal radioulnar joint (ARCD). The radial CFCT is supplied by the anterior interosseous artery. A radial injury with distal radioulnar instability must be repaired, as well as a central injury, so that it does not continue towards the ligaments generating instability. Materials and methods: A retrospective study were developed to analyze the surgeries performed in patients with Palmer 1D radial CFCT lesions. Eleven male patients of 32.8 years average age were studied. All the patients were strength workers and 72.7% were athletes. The average follow-up was 18.4 months. Results: eleven patients of working age. 63.6% of skilled hands. 100% of patients presented a 1D Palmer lesion. The visual analog scale of preoperative pain was 8 and postoperative was 1. The Dash score was 85.8 preoperative and 1.18 postoperative. The May wrist score was excellent in six patients and good in five. Conclusion: the dorsal and radiocubital ligaments are essential to maintain adequate distal radiocubital stability and that they have adequate irrigation that allows their repair, for which reason their re-clamping is indicated. The arthroscopic technique without tunnel exposed in this work allows the CFCT to be re-anchored without tunnels and complex techniques with very good results in most cases. Level of Evidence: IV

Clinical observation of different surgical methods for metaphyseal sequelae of ulna / 中国骨伤

OBJECTIVE@#To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna.@*METHODS@#From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth.@*RESULTS@#All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (@*CONCLUSION@#Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.

Design of Monitorable Wrist Orthosis Based on 3D Printing / 中国医疗器械杂志

A 3D printing based wrist orthosis device was developed. After collecting the contour information of the carpal and metacarpophalangeal joints of the patients with a 3D scanner, the wrist orthotics were designed to meet the individual needs of the patients according to the relevant requirements of biomechanics. Choose TPU (thermoplastic polyurethanes) materials for preparation of 3D printing. It can functionally assist the smart brace after stroke patients with hemiplegia early rehabilitation training, the use of orthoses carry MPU6050 inertial sensor, magnetometer, time module device such as a sensor and monitor its movements and record the training time, ensure safe efficient rehabilitation training, help patients return to a normal life as soon as possible.