RESUMEN
In wrist arthroscopy, the standard dorsal portals are the most commonly used. However, their placement can be associated with injuries to the neurovascular structures of the radiocarpal joint. The present study assessed and compared the distance of commonly used dorsal portals to radial and ulnar neurovascular structures. Forty patients (20 males, 20 females) were evaluated with T1-weighted spin-echo (SE) magnetic resonance (MR) sequences. We measured the distance between 1-2 and 3-4 portals and radial vascular bundle and the nearest branch of the superficial branch of radial nerve (SBRN). We also measured the distance between 4 and 5, 6/U and 6/R and ulnar vascular bundle and the nearest branch of the dorsal ulnar nerve (DUN). The median age of patients was 39 years (95% IC 36.97-43.32 years). The 3-4 portal was farther away from the vascular structure than the 1-2 portal (P < 0.0001), 4-5 portal (P = 0.008), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). Moreover, the 3-4 portal was farther away from the nerve branch than the 1-2 portal (P < 0.0001), 4-5 portal (P < 0.0001), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). No statistical significant differences were found between the two genders. The 3-4 and 4-5 portals are the farthest away from the neurovascular structures, and likely reduce the risk to damage these structures. On the other hand, the 1-2 and 6/U portals likely increase the risk of neurovascular damage, because of their proximity to neurovascular structures. LEVEL OF EVIDENCE: Diagnostic study; Level III.
Asunto(s)
Artroscopía/métodos , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Adulto , Artroscopía/efectos adversos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Traumatismos de los Nervios Periféricos/etiología , Traumatismos de los Nervios Periféricos/prevención & control , Articulación de la Muñeca/inervaciónAsunto(s)
Articulación del Hombro , Tuberculosis Osteoarticular/diagnóstico , Antituberculosos/administración & dosificación , Diagnóstico Tardío , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Radiografía , Rango del Movimiento Articular , Articulación del Hombro/diagnóstico por imagen , Articulación del Hombro/microbiología , Articulación del Hombro/patología , Articulación del Hombro/fisiopatología , Dolor de Hombro/microbiología , Tuberculosis Osteoarticular/diagnóstico por imagen , Tuberculosis Osteoarticular/tratamiento farmacológico , Tuberculosis Osteoarticular/patología , Tuberculosis Osteoarticular/fisiopatologíaRESUMEN
We report the clinical features, radiographic findings, management, and results of a patient with bilateral hallux valgus and associated bilateral tibial hallux sesamoid agenesis and fibular hallux sesamoid hypoplasia. Our patient was managed operatively with good clinical results. Combined tibial sesamoid agenesis and fibular sesamoid hypoplasia do not seem to negatively influence the management of hallux valgus.