[Dislocation due to injury with trajectory in the scaphoid-trapezoid-trapezoid periscaphoid-perisemilunar bones. Case report and literature review]. / Luxación por lesión con trayecto en los huesos escafoide-trapecio-trapezoidea periescafo-perisemilunar. Reporte de caso y revisión de la literatura.

INTRODUCTION: dislocations of carpal bones without associated fractures are considered a rare injury, the most common mechanism of injury being axial loading with wrist in extension plus ulnar deviation. The literature reports a wide variety of complex carpal injuries, even so, it is possible to identify previously undescribed injuries. OBJECTIVE: to present an atypical case of a patient with an injury to the midcarpal stabilizing mechanism and the stabilizing mechanism of the proximal row of the wrist following trauma to the hand that required carpectomy as definitive surgical treatment. PRESENTATION OF CASE: a 48 year old male patient is presented who is admitted to our hospital unit after presenting injury to the left hand after being run over by a motor vehicle, with axial load mechanism, presenting deformity in the left thoracic extremity, fracture of the proximal metaphysis of the second phalanx of the third finger as well as dislocation of the proximal interphalangeal joint, with traumatic amputation of the second phalanx of the fourth finger plus extensor injury in zone V of the fifth finger with loss of skin coverage of the fourth and fifth finger, attending our hospital unit 24 hours after the injury. CONCLUSIONS: carpal bone dislocations are an orthopedic emergency, with 20% going unnoticed in trauma centers. Early closed reduction is the initial treatment to avoid severe complications, however, surgical treatment is the gold standard for fixation. Carpectomy is considered a mostly adequate sequelae management treatment, however it is well accepted for complex injuries to the wrist stabilization mechanisms, as it can be performed in a short surgical time and early rehabilitation can be initiated and functional ranges of motion can be achieved with low sequelae.

INTRODUCCIÓN: las luxaciones de los huesos del carpo sin presentar fracturas asociadas se considera una lesión infrecuente; el mecanismo de lesión más común es la carga axial con muñeca en extensión más desviación cubital. La literatura reporta una gran variedad de lesiones complejas del carpo; aun así, es posible identificar lesiones no descritas previamente. OBJETIVO: presentar caso atípico de paciente con lesión a nivel del mecanismo estabilizador medio-carpiana y estabilizador de la fila proximal de la muñeca posterior a traumatismo en mano que requirió carpectomía como tratamiento quirúrgico definitivo. PRESENTACIÓN DEL CASO: paciente masculino de 48 años de edad, quien ingresa a nuestra unidad hospitalaria tras sufrir lesión en mano izquierda posterior a ser arrollado por vehículo automotor, con mecanismo de carga axial, presentando en extremidad torácica izquierda deformidad hacia volar, fractura de metáfisis proximal de segunda falange del tercer dedo así como luxación de articulación interfalángica proximal, con amputación traumática de segunda falange del cuarto dedo más lesión extensora en zona V del quinto dedo con pérdida de cobertura cutánea del cuarto y quinto dedos. Acude a nuestra unidad hospitalaria 24 horas después de la lesión. CONCLUSIONES: las luxaciones en huesos del carpo es una urgencia ortopédica, pasando desapercibidas en 20% en centros de traumatología. La reducción cerrada temprana es el tratamiento inicial para evitar complicaciones severas; sin embargo, el tratamiento quirúrgico es el estándar de oro para la fijación de las mismas. La carpectomía se considera un tratamiento mayoritariamente para el manejo adecuado de secuelas; sin embargo, es bien aceptado para las lesiones complejas que se presentan en los mecanismos estabilizadores de la muñeca, dado a que se puede realizar en un tiempo quirúrgico y se puede iniciar una rehabilitación temprana, con lo que se pueden alcanzar rangos de movimientos funcionales y con bajo grado de secuelas.

Carpectomía proximal en paciente con artrosis de muñeca / Proximal row carpectomy in patient with wrist osteoarthritis

Resumen: La artrosis de la muñeca es un proceso degenerativo, postraumático o idiopático que provoca al paciente dolor, pérdida de la movilidad, inflamación y deformidad. Las opciones quirúrgicas incluyen: artrodesis total de muñeca que produce una mejoría del dolor y disminución de la inflamación, otros tratamientos que permiten movilidad relativa son las artrodesis parciales. Otra solución quirúrgica es la carpectomía o la resección de la primera hilera del carpo, de tal manera que constituya una nueva articulación entre el radio y la segunda fila del carpo, obteniendo una congruencia articular adecuada. Material y métodos: Estudio observacional, descriptivo, serie de casos. Se valoraron 15 pacientes con carpectomía proximal durante el período de Enero de 2007 a Agosto de 2009, a quienes se realizó medición de arcos de movilidad y fuerza mediante las escalas de Mayo-DASH. Resultados: En 80% de los pacientes entre 35 y 64 años se encontró predominio del sexo masculino en 67%. La mejoría del dolor fue evidente, pasando de una media 7.7 en el preoperatorio a 2.7 en el postoperatorio, 10% de los casos presentaron dolor residual. Conclusiones: La carpectomía proximal representa una alternativa terapéutica que permite conservar la movilidad con mejora del dolor en la artrosis de muñeca.

Abstract: The arthrosis of the wrist is a degenerative, traumatic or idiopathic process, which cause problem for patient characterized by pain, loss of mobility, swelling and deformity of the affected wrist. A surgical alternative is proximal row carpectomy, which consists of resection of the lunate, scaphoid and triquetrum, forming a new joint between the radius and the distal row carpus. Material and methods: Observational, descriptive, case series. 15 patients were evaluated who underwent proximal row carpectomy during the period January 2007-August 2009, with clinical follow-up until august 2010 through mayo and DASH scores, measuring strength. Range of motion and pain. 80% of patients were between 35 and 64 years. The predominant sex was male in 67%. The result was satisfactory in 73%, according to the scale of Mayo. The DASH scale in the postoperative period also improves. Conclusions: The proximal carpectomy is a surgical alternative, it preserves some joint mobility, reduced pain and improved disability of the limb.

[Proximal row carpectomy in patient with wrist osteoarthritis]. / Carpectomía proximal en paciente con artrosis de muñeca.

The arthrosis of the wrist is a degenerative, traumatic or idiopathic process, which cause problem for patient characterized by pain, loss of mobility, swelling and deformity of the affected wrist. A surgical alternative is proximal row carpectomy, which consists of resection of the lunate, scaphoid and triquetrum, forming a new joint between the radius and the distal row carpus. Material and methods: Observational, descriptive, case series. 15 patients were evaluated who underwent proximal row carpectomy during the period January 2007-August 2009, with clinical follow-up until august 2010 through mayo and DASH scores, measuring strength. Range of motion and pain. 80% of patients were between 35 and 64 years. The predominant sex was male in 67%. The result was satisfactory in 73%, according to the scale of Mayo. The DASH scale in the postoperative period also improves. Conclusions: The proximal carpectomy is a surgical alternative, it preserves some joint mobility, reduced pain and improved disability of the limb.

La artrosis de la muñeca es un proceso degenerativo, postraumático o idiopático que provoca al paciente dolor, pérdida de la movilidad, inflamación y deformidad. Las opciones quirúrgicas incluyen: artrodesis total de muñeca que produce una mejoría del dolor y disminución de la inflamación, otros tratamientos que permiten movilidad relativa son las artrodesis parciales. Otra solución quirúrgica es la carpectomía o la resección de la primera hilera del carpo, de tal manera que constituya una nueva articulación entre el radio y la segunda fila del carpo, obteniendo una congruencia articular adecuada. Material y métodos: Estudio observacional, descriptivo, serie de casos. Se valoraron 15 pacientes con carpectomía proximal durante el período de Enero de 2007 a Agosto de 2009, a quienes se realizó medición de arcos de movilidad y fuerza mediante las escalas de Mayo-DASH. Resultados: En 80% de los pacientes entre 35 y 64 años se encontró predominio del sexo masculino en 67%. La mejoría del dolor fue evidente, pasando de una media 7.7 en el preoperatorio a 2.7 en el postoperatorio, 10% de los casos presentaron dolor residual. Conclusiones: La carpectomía proximal representa una alternativa terapéutica que permite conservar la movilidad con mejora del dolor en la artrosis de muñeca.

Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis / Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis

Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado. Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH. Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8. Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados. Nivel de Evidencia: IV

Objective: To report the consolidation rate and the outcomes of a series of 22 patients with proximal pole scaphoid nonunion treated with a metaphyseal core decompression and an anterograde self-compressing screw. Methods: We present a prospective series of patients with proximal pole scaphoid nonunion and confirmation of intraoperative bleeding in both fragments. Patients presented with displacement, degenerative changes, proximal pole fragmentation, cavitation at the fracture site, reduced bone length, and necrosis, as well as those with carpal instability, were excluded. X-rays and computed tomography scans were performed to assess consolidation; range of motion and grip strength were recorded, and patients completed a visual analogue scale for pain at rest, pain during activity, and subjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire. Results: Eighteen patients were included. Union was observed in 17 patients. The average follow-up time was 22 months and the average final range of motion was as follows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnar deviation, and 85% for grip strength. The average score on the visual analogue scale was 0 point for pain at rest, 2 for pain during activity, and 9 for function, while average DASH score was 8. Conclusions: Using this simple and reliable technique, we obtained 95% union and very good functional results. Metaphyseal core decompression with an antegrade screw is a valid and effective alternative for the treatment of proximal pole scaphoid nonunion in carefully selected patients. Level of Evidence: IV

Perilunate carpal dislocation. Clinical evaluation of patients operated with reduction and percutaneous fixation without capsular-ligament repair / Luxação perilunar do carpo. Avaliação clínica de casos operados com redução e fixação percutânea, sem reparo cápsulo-ligamentar

ABSTRACT OBJECTIVE: To qualitatively assess surgeries performed in patients with perilunate dislocations without associated fractures, who were operated using the closed reduction and percutaneous fixation method. The follow-up time ranged from one to seven years. METHODS: 628 patient records with traumatic wrist injuries, operated by the same group of Hand Surgeons between 2008 and 2014 due to acute trauma were collected, with a mean follow-up of 3.2 years. Of these, 51 were cases of perilunate fracture-dislocations, and 38 were pure perilunate dislocations without associated fractures; of these, only 32 underwent percutaneous fixation without ligamentous repair, thus meeting the inclusion criteria. Of the nine patients with perilunate dislocations who were treated using the closed reduction and percutaneous fixation method, whose mean age was 38 years (range 26-49 years), the dominant side was the left in two-thirds of the cases, and the predominant trauma mechanism was direct trauma. RESULTS: This study is in agreement with the literature, showing that cases treated early present good results. CONCLUSION: 88% of patients who were treated by closed reduction and percutaneous fixation method maintained their daily activities and were assessed as excellent or good by the Clinical Scoring Chart.

RESUMO OBJETIVO: Fazer uma avaliação qualitativa das cirurgias feitas em pacientes que sofreram luxações perilunares, sem fraturas associadas, que foram operados com o método de redução incruenta e fixação percutânea. O tempo de seguimento variou entre um e sete anos. MÉTODOS: Foram levantados prontuários de 628 pacientes, sob a denominação de lesões traumáticas no punho, operados pelo mesmo grupo de cirurgiões de mão, entre 2008 a 2014, com seguimento médio de 3,2 anos, devido a traumas agudos. Desses, 51 foram casos de fraturas-luxações perilunares, 38 eram luxações perilunares puras, sem fraturas associadas; dessas, apenas 32 tiveram fixação percutânea, sem reparo ligamentar, contemplaram assim os requisitos da pesquisa. Dos nove pacientes com luxações perilunares que foram tratados pelo método de redução fechada e fixação percutânea, com média de 38 anos (26 a 49), o lado dominante foi o esquerdo em 2/3 dos casos, o mecanismo de trauma predominante foi o direto. RESULTADOS: Este estudo convergiu com outros trabalhos na literatura, mostrou que os casos tratados precocemente apresentam bons resultados. CONCLUSÃO: Mantiveram suas atividades de vida diária e foram avaliados como excelentes ou bons pelo Clinical Scoring Chart 88% dos pacientes que foram tratados pelo método de redução fechada e fixação percutânea

Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis.

BACKGROUND: Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis. METHODS: Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis. RESULTS: Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent. CONCLUSIONS: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.

Fractura luxación axial del carpo. Reporte de tres casos y revisión de la literatura / Axial-fracture dislocation of the carpal bone, report of three cases and literature review

Reportamos tres casos de fractura de luxación axial del carpo tratados en nuestro servicio. Los tres, hombres entre la tercera y cuarta décadas de la vida, que sufrieron accidentes laborales por aplastamiento. En todos los casos se realizó reducción abierta y estabilización con clavillos, posteriormente fueron enviados a medicina física y rehabilitación. Se valoró la función de la muñeca a los diez meses con la escala de la Clínica Mayo para la muñeca (Mayo Wrist Score) y se tomaron estudios radiográficos para evaluar sus resultados postoperatorios. En este escrito se exponen tres ejemplos de pacientes que sufrieron estas lesiones con desenlaces "bueno", "satisfactorio" y "pobre".

We report three cases of axial-fracture dislocation of the carpal bone treated in our department. The three men were between thirty and forty years old who had a work related crushing fracture. We performed an open reduction and stabilization with pins in all cases; patients were then referred to physical medicine and rehabilitation. We assessed the wrist function at ten months using the Mayo Wrist Score and with X-rays to evaluate postoperative results. In this summary we present three examples of patients who suffered these injuries with "good", "satisfactory" and "poor" outcomes.

[Axial-fracture dislocation of the carpal bone, report of three cases and literature review]. / Fractura luxación axial del carpo. Reporte de tres casos y revisión de la literature.

We report three cases of axial-fracture dislocation of the carpal bone treated in our department. The three men were between thirty and forty years old who had a work related crushing fracture. We performed an open reduction and stabilization with pins in all cases; patients were then referred to physical medicine and rehabilitation. We assessed the wrist function at ten months using the Mayo Wrist Score and with X-rays to evaluate postoperative results. In this summary we present three examples of patients who suffered these injuries with "good", "satisfactory" and "poor" outcomes.

Osteotomía de horizontalización de la glenoide radial en la seudoartrosis del escafoides carpiano / Ostéotomie d'horisontalisation de la glène radiale dans la pseudarthrose du scaphoïde carpien / Horizontalization osteotomy of the radial glenoid in seudoarthrosis of the carpal scaphoid bone

Objetivo: presentar los resultados de una osteotomía de cierre cuneiforme del extremo distal del radio para suprimir el dolor, mejorar la función, movilidad y fuerza en pacientes portadores de artrosis de la articulación radio-carpiana, secundaria a una seudoartrosis del escafoide. Además lograr su introducción en el arsenal terapéutico cubano. Métodos: de enero de 2009 a junio 2010 se realizaron 11 osteotomías de horizontalización de la glenoide radial en 7 trabajadores manuales y 4 intelectuales, del sexo masculino, con una edad promedio de 36 años (entre 24 y 49 años); y un tiempo de latencia promedio de 6 años (entre 1 y 14 años). La técnica consistió en la resección de una cuña ósea, 2 cm proximal al extremo de la apófisis estiloides, base lateral de 0,5 a 1 cm y centrada en la articulación radio cubital distal, sin modificación de la longitud del radio. Resultados: se evaluaron mediante la aplicación del score de Cooney con resultados excelentes en 6 pacientes (54,5 por ciento), buenos en 4 (36,3 por ciento) y regulares en 1 (9,2 por ciento).Todos pudieron incorporarse a sus labores. Conclusiones: la osteotomía de horizontalización produce una disminución marcada del dolor al disminuir la presión entre las superficies articulares del radio y el escafoide, lo cual redunda en una mayor movilidad, fuerza y función de la mano(AU)

Objective: to present the results of a wedge osteotomy of the distal radius to alleviate pain, improve function, mobility and strength in patients with arthrosis in the radio - carpal joint secondary to seudoarthrosis in the scaphoid bone. Also, to introduce it in the Cuban therapeutic arsenal. Methods: from January 2009 to June 2010, 11 horizontalization osteotomies of the radial glenoid were performed in 7 manual workers and 4 intellectual ones, male, with an average age of 36 years (between 24 and 49 years) and an average latency time of 6 years (between 1 and 14 years). The technique consisted on the resection of the cuneiform bone 2 cm proximal to the terminal portion of the styloid apophysis, with a lateral base of 0.5-1 cm and centred in the distal radioulnar joint without modification of the length of the radius. Results: patients were assessed by applying the Cooney score with excellent results in 6 of them (54.5 percent), good in 4 (36.3 percent) and regular in 1 patient (9.2 percent). All patients could return to work. Conclusions: horizontalization osteotomy produces a marked pain reduction when diminishing pressure between joint surfaces of the radius and the scaphoid what leads to a greater mobility, strength and function of the hand(AU)

But: ce travail est visé à présenter les résultats d'une ostéotomie de fermeture cunéiforme de la portion distale du radius afin de soulager la douleur, d'améliorer la fonction, la mobilité et la force chez les patients atteints d'arthrose de l'articulation radio-carpienne, après une pseudarthrose du scaphoïde, et d'aboutir aussi à son introduction dans l'arsenal thérapeutique cubain. Méthodes: onze ostéotomies d'horisontalisation de la glène radiale ont été effectuées de janvier 2009 à juin 2010 chez 7 travailleurs manuels et 4 intellectuels, du sexe masculin, âgés de 36 ans en moyenne (entre 24 et 49 ans), et un temps moyen de latence de 6 ans (entre 1 et 14 ans). La technique a consisté en la résection d'un coin osseux, 2 cm de la portion proximale de l'apophyse styloïde, base latérale de 0,5 à 1 cm, et centrée sur l'articulation radio-cubitale distale, sans modifications de la longitude du radius. Résultats: six patients ont été évalués par l'échelle de Cooney avec des résultats excellents (54,5 pourcent), 4 patients avec de bons résultats (36,3 pourcent), et 1 patient avec des résultats passables (9,2 pourcent). Tous ces patients se sont réincorporés à la vie quotidienne. Conclusions: l'ostéotomie d'horisontalisation favorise le soulagement de la douleur, en diminuant la pression entre les superficies articulaires du radius et du scaphoïde, et en récupérant la mobilité, la force et la fonction de la main(AU)

Metaphyseal ulnar shortening osteotomy for the treatment of ulnocarpal abutment syndrome using distal ulna hook plate: case series.

PURPOSE: To determine the efficacy of a transverse ulnar-shortening osteotomy at the metaphysis in combination with osteosynthesis using a low-profile, 2.0-mm, locking compression distal ulna plate for the treatment of ulnocarpal abutment syndrome. METHODS: We enrolled into this prospective case series 6 patients with symptomatic ulnocarpal abutment syndrome without distal radioulnar joint ligamentous instability, who had previously failed conservative treatment. We recorded Quick Disability of Arm, Shoulder, and Hand score; wrist range of motion; and visual analog scale score for pain before and after surgery for statistical comparisons. RESULTS: All parameters improved after the surgery. The Quick Disabilities of the Arm, Shoulder, and Hand improved from a mean of 65 to 17, and the visual analog score improved from a mean of 7 to 2. No hardware removal was required and no complications were reported. CONCLUSIONS: Metaphyseal ulnar-shortening osteotomy provided the functional advantages of a midshaft ulnar-shortening osteotomy with the potential for improved bone healing and the reduced risk for complications. This technique was a useful alternative for treatment of ulnocarpal abutment syndrome, especially in patients with more than 2 mm ulnar positive variance. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study.

OBJECTIVE: To compare the functional results of carpectomy and four-corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS: In this prospective randomized study, 20 patients underwent proximal row carpectomy or four-corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS: Both proximal row carpectomy and four-corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS: Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non-union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.

Comparison between proximal row carpectomy and four-corner fusion for treating osteoarthrosis following carpal trauma: a prospective randomized study

OBJECTIVE: To compare the functional results of carpectomy and four-corner fusion surgical procedures for treating osteoarthrosis following carpal trauma. METHODS: In this prospective randomized study, 20 patients underwent proximal row carpectomy or four-corner fusion to treat wrist arthritis and their functional results were compared. The midcarpal joint was free of lesions in all patients. RESULTS: Both proximal row carpectomy and four-corner fusion reduced the pain. All patients had a decreased range of motion after surgery. The differences between groups were not statistically significant. CONCLUSIONS: Functional results of the two procedures were similar as both reduced pain in patients with scapholunate advanced collapse/scaphoid non-union advanced collapse (SLAC/SNAC) wrist without degenerative changes in the midcarpal joint.

Pathology and therapeutic results in patients with intraosseous ganglia of the carpal bone.

This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.

Portales artroscopicos radiocarpianos y mediocarpianos: anatomia aplicada y tecnica quirurgica / Radiocarpal and midcarpal arthroscopic portals: anatomy and surgical technique

En este trabajo se presentan una serie de medidas generales para la realizacion de artroscopias de muñeca. Se hace una introduccion con la anatomia aplicada y la tecnica quirurgica basica para la colocacion de los diferentes portales y la aplicacion clinica de los portales mas utilizados para la artroscopia de muñeca tanto radiocarpiana como mediocarpiana.

Portales artroscopicos radiocarpianos y mediocarpianos: anatomia aplicada y tecnica quirurgica / Radiocarpal and midcarpal arthroscopic portals: anatomy and surgical technique

En este trabajo se presentan una serie de medidas generales para la realizacion de artroscopias de muñeca. Se hace una introduccion con la anatomia aplicada y la tecnica quirurgica basica para la colocacion de los diferentes portales y la aplicacion clinica de los portales mas utilizados para la artroscopia de muñeca tanto radiocarpiana como mediocarpiana.(AU)

Pathology and therapeutic results in patients with intraosseous ganglia of the carpal bone / Patología y resultados terapéuticos en los pacientes con ganglión intraóseo del hueso carpiano

This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.

Este estudio evaluó la patología y resultados terapéuticos de siete pacientes con ganglión intraóseo del hueso carpiano. La edad promedio en el momento de la cirugía fue 27.6 años. Las lesiones se localizaban en la fila proximal del carpo en seis pacientes y en la fila distal carpiana solamente en uno. El tratamiento quirúrgico se realizó en todos los pacientes con buena unión ósea. Ninguno tuvo dolor durante la actividad o el reposo, y no había tenido lugar recurrencia alguna. El ganglión intraóseo en cuatro pacientes fue de tipo idiopático, y en los otros tres pacientes fue de tipo penetrante. Aunque el ganglión intraóseo del hueso carpiano se informa como una enfermedad rara, se reportaban 159 casos en la literatura. La patología consistía en un desarrollo intra- o extraóseo, con variación, pero la mayoría de los casos se localizaban en la fila proximal carpiana.

Semilunar flotante: tratamiento artroscopico: reporte de un caso y revision de la bibliografia / Floating lunate: arthroscopic treatment: case report and bibliography review

La asistencia artroscópica ha beneficiado de manera significativa el diagnóstico y tratamiento de la inestabilidad carpiana. Presentamos un caso clínico en donde se combinan dos lesiones ligamentarias carpianas, la lesión del ligamento escafo-lunar y la del luno-piramidal. Ambas corresponden a lesiones pre-dinámicas y de grado III según la clasificación de Geissler. Describimos el tratamiento quirúrgico en donde se realizó en forma artroscópica termo contracción y fijación temporaria con clavijas. Pasados dos años de seguimiento no se han observado nuevos signos de inestabilidad ni dolor residual.

Fracturas del escafoides carpiano: tratamiento percutaneo bajo asistencia artroscopica / Scaphoid fractures: percutaneous treatment with arthroscopic assistance

La consolidación del escafoides carpiano puede ser alterada por múltiples factores, aún en fracturas con mínimo desplazamiento y biomecánicamente estables. La ténica de fijación percutánea reduce el daño vascular y de los ligamentos cardinales de la muñeca, acortando los tiempos de consolidación, inmovilización e incapacidad laboral y/o deportiva. Este enfoque obliga a precisar el diagnóstico de las lesiones asociadas, que en caso de existir, influirían negativamente sobre el resultado final del tratamiento. La artroscopía, por tanto, se ha convertido en un elemento valioso para el tratamiento quirúrgico de las fracturas del escafoides carpiano y sus lesiones asociadas.