[Trans-scapho-perilunar fracture-dislocation: a case report]. / Fractura-luxación transescafo-perilunar: reporte de un caso clínico.

Trans-scaphoid perilunate fractures-dislocations are rare injuries caused by high-energy trauma of the wrist. Diagnosis is based on medical history, physical examination, and tools such as radiographs, computed tomography scan, and magnetic resonance imaging. Early treatment consists of closed reduction and casting to stabilize the limb. Definitive treatment is surgical and includes bone and soft tissue repair. A case of trans-scaphoid perilunate fracture-dislocation is presented, along with diagnosis, management and outcome.

Las fracturas-luxaciones transescafo-perilunares son lesiones infrecuentes causadas por impactos de alta energía hacia la muñeca. El diagnóstico se basa en la historia clínica, exploración física y herramientas como la radiografía, la tomografía computarizada y la resonancia magnética. El manejo inmediato consiste en una reducción cerrada e inmovilización para estabilizar la extremidad. El tratamiento definitivo es de carácter quirúrgico e incluye la reparación ósea y de tejidos blandos. Se presenta un caso de fractura-luxación transescafo-perilunar, su diagnóstico, manejo y evolución.

Distal Radial Fractures with Scaphoid Fractures / Fraturas do rádio distal associadas à fratura do escafoide

Abstract Objective This study evaluated the epidemiological data and functional outcomes from patients with concomitant distal radial and scaphoid fractures treated in a single center specialized in hand surgery. Functional outcomes analysis used validated instruments. Methods Patients diagnosed with distal radial and scaphoid fractures treated from January 2011 to December 2021 underwent assessments using the Disabilities of the Arm, Shoulder and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), Visual Analog Scale (VAS) for pain, goniometry, radiographic consolidation, and complications six months after surgery. Results The study included 23 patients, 73.9% men and 26.1% women. Most (56.5%) fractures occurred on the right side, and 43.5% happened on the left side. Treatment of most (56%) distal radial fractures used a locked volar plate. Functional assessment by PRWE resulted in a mean score of 35.9 points (range, 14 to 71 points), while DASH showed a mean score of 37.8 points (range, 12 to 78 points). The mean VAS was 2.33 during activities (range, 0.6 to 6.2). Conclusion Distal radial fractures associated with scaphoid fractures resulted from high-energy trauma, and most patients were males. There was a low rate of complications with surgical treatment, and the patients had satisfactory functional evolution with a low level of pain.

Resumo Objetivo Avaliar os resultados epidemiológicos e funcionais dos pacientes que apresentaram fraturas concomitantes do rádio distal e do escafoide e foram tratados em um único centro especializado em cirurgia da mão, através de instrumentos validados para analisar os desfechos funcionais desses pacientes. Métodos Foram avaliados os pacientes com diagnóstico de fratura do rádio distal e escafoide tratados de janeiro de 2011 até dezembro de 2021, através dos questionários Disabilities of the Arm, Shoulder and Hand (DASH), Patient Rated Wrist Evaluation (PRWE) e Escala Visual Analógica da dor (EVA); goniometria; consolidação radiográfica; complicações em seis meses de pós-operatório. Resultados Vinte e três pacientes foram incluídos no estudo, sendo 73,9% homens e 26,1% mulheres; 56,5% das fraturas ocorreram à direita e 43,5% à esquerda. A maioria das fraturas do rádio distal foi tratada com placa volar bloqueada, totalizando 56%. Na avaliação funcional pelo PRWE, obteve-se média de 35,9 pontos (variação de 14 a 71 pontos) e pelo DASH média de 37,8 pontos (variação de 12 a 78 pontos). A EVA apresentou uma média de 2,33 durante a atividade (variação de 0,6 a 6,2). Conclusão Verificou-se que as fraturas do rádio distal associadas a fraturas do escafoide foram causadas por traumas de alta energia, com o sexo masculino mais acometido. Houve baixo índice de complicações com tratamento cirúrgico e os pacientes tiveram evolução funcional satisfatória, com baixo índice de dor.

Late consolidation of the scaphoid. Case report and literature review.

Scaphoid fractures are a common wrist injury accounting for 2-7% of all adult fractures. Nonunion is described in 5-12% of cases leading to osteoarthritis. Several classifications have been developed focused on this pathology and its complication. We present a case of a 28 years old male patient with a scaphoid fracture and nonunion who spontaneously consolidates without treatment. We performed a literature review to recognize this pathology, its common evolution and possible treatment options.

Las fracturas de escafoides son una lesión frecuente de la muñeca y representan de 2-7% de todas las fracturas en adultos. La no unión se describe en 5-12% de los casos y conduce a la osteoartritis. Se han desarrollado varias clasificaciones centradas en esta patología y su complicación. Presentamos el caso de un paciente varón de 28 años con fractura y no unión de escafoides que consolida espontáneamente sin tratamiento. Realizamos una revisión bibliográfica para reconocer esta patología, su evolución habitual y las posibles opciones de tratamiento.

Anterior dislocation of the lunate due to a high-energy trauma.

Semilunate and perilunate dislocation is an injury that mostly occurs when the subject is exposed to a high-energy trauma. Considered severe, it compromises the stability and function of the wrist. The case presented is that of a 50-year-old male patient who after having a motorcycle accident arrived at the ER with neurovascular affectation, swelling, deformity and a considerable decrease of the wrist joint movement. He was also referring severe pain. A Henry (Volar) intervention was done with the help of external fixation of the lunate, followed by K-wire fixation, once a prior closed reduction was unsuccessfully attempted. The scaphoid was connected to the semilunate, and then the latter with the capitate. Ligament reconstruction followed, and stability was clinically confirmed with an X-ray. Although improvement of symptomatology was observed during the follow-up analysis, motion of the wrist remained limited. Even with the best treatment, in terms of functionality, this type of injury presents a poor prognosis.

La luxación semilunar y perilunar es una lesión que se produce principalmente cuando el sujeto está expuesto a un traumatismo de alta energía. Considerada grave, compromete la estabilidad y la función de la muñeca. El caso presentado es el de un paciente varón de 50 años que tras sufrir un accidente de motocicleta llegó a urgencias con afectación neurovascular, tumefacción, deformidad y una considerable disminución del movimiento articular de la muñeca. También refería fuertes dolores. Se realizó una intervención de Henry (Volar) con la ayuda de fijación externa del lunar, seguida de fijación con agujas de Kirschner, una vez que se había intentado sin éxito una reducción cerrada previa. El escafoides se conectó con el semilunar y luego éste con el capitado. A continuación se reconstruyó el ligamento y se confirmó clínicamente la estabilidad con una radiografía. Aunque se observó una mejora de la sintomatología durante el análisis de seguimiento, el movimiento de la muñeca seguía siendo limitado. Incluso con el mejor tratamiento, en términos de funcionalidad, este tipo de lesión presenta un mal pronóstico.

Comparative analysis of cancellous graft and cortico-cancellous graft in osteosynthesis of scaphoid pseudoarthrosis with plate.

INTRODUCTION: Scaphoid is the most fractured carpal bone, with a 5-10% nonunion rate. Treatment challenges include choosing the implant and graft that best corrects humpback deformity and carpal malalignment with higher chances of bony healing. OBJECTIVE: Compare cortico-cancellous and cancellous grafts between two groups of patients treating scaphoid nonunion with locking plates using autologous bone graft and evaluate bone healing rates and radiographic, tomographic, and functional parameters before and after surgery. METHODS: Non-randomized prospective study including 20 cases of scaphoid nonunion. Groups were divided into Group A (ten patients treated with cortico-cancellous iliac graft) and Group B (ten patients treated with cancellous iliac graft). Patients underwent pre- and postoperative radiographs, computed tomography, and functional evaluation. RESULTS: In postoperative analysis, Group A showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle (p = 0.011) correction when comparing the pre- and postoperative periods. Group B showed a statistically significant difference in intrascaphoid angle (p = 0.002) and scapholunate angle correction (p = 0.0018), grip strength (p = 0.002), and tip pinch strength (p = 0.001) when comparing the pre- and postoperative periods. By comparing both groups, Group B showed a statistically significant difference in intrascaphoid angle correction (p = 0.002), grip strength (p = 0.002), tip pinch strength (p = 0.002), and radial deviation (p = 0.0003). There was no statistical difference when comparing bony healing between groups. CONCLUSION: Scaphoid nonunion treatment with a locking plate was effective, showing a high bony healing rate and improved carpal alignment in imaging tests for both graft types. However, results for intrascaphoid angle correction, grip strength, tip pinch strength, and radial deviation were better in Group B. LEVEL OF EVIDENCE: IV, case series.

360-degree Arthroscopic Management of Scaphoid Pseudarthrosis: Description of Technique and Indications.

Nonunion remains one of the main complications of scaphoid fractures, with no consensus being reached as to the best surgical technique for scaphoid pseudoarthrosis. Thus, different types of procedures for bone stability and biological stimulus for consolidation have been described. The use of arthroscopy for scaphoid pseudoarthrosis has advantages as it allows for treating associated injuries, preserving wrist proprioception by minimizing damage to the joint capsule and ligaments and not deteriorating the already fragile scaphoid vasculature, leading to a quick recovery. Arthroscopy was initially indicated for stable scaphoid pseudoarthroses, being used in all patterns of this condition, including unstable ones and those with flexion collapse. However, most scientific articles describe the use of arthroscopy only through the dorsal portals, creating technical difficulty in complete debridement of the site of pseudarthrosis and in placing bone graft. This study describes the 360-degree technique, which standardizes arthroscopy in scaphoid pseudoarthrosis treatment, allowing, with the use of dorsal, volar, and radial portals, direct approach to the entire circumference of the nonunion site, facilitating the debridement of the injury site, the correction of the scaphoid deformity, and the placement of a graft directly on the site of the defect, mainly in its volar region after correction of the flexion deformity. The 360-degree technique aims to help and standardize the arthroscopic procedure for scaphoid pseudarthrosis, creating a routine with defined surgery stages. Additional portals allow complete access to the entire nonunion site and better positioning of the bone graft under direct view.

Comparative analysis of scaphoid nonunion treatment with screw fixation and angular stable plate.

INTRODUCTION: Scaphoid fractures represent 5-10% of nonunion rate and the treatment options consist of an open reduction with correction of deformity, restoration of the scaphoid length with autologous wedge grafting and fixation. However, there is still no consensus in the literature on the best fixation method. Therefore, the purpose of the study is to compare plate fixation and screw fixation in treating scaphoid nonunion with humpback deformity and carpal instability. METHODS: Prospective, non-randomised study comparing the treatment of two groups of patients with scaphoid nonunion. A total of 19 patients were included in the study, the first ten patients were included in group 1 (plate fixation), subsequently nine patients were included in group 2 (screw fixation). The nonunion duration was longer than 6 months and patients did not present type III Scaphoid Nonunion Advanced Collapse (SNAC). Clinical evaluations included pain intensity, range of motion, grip strength, pinch test and functional scales Disabilities of the Arm, Shoulder and Hand (DASH) and Mayo Wrist Score. Radiographic evaluations consisted of radiographs of both wrists in AP, AP with ulnar deviation, lateral and oblique views. Patients further underwent a tomography of the affected wrist for bone deformity, carpal collapse and later consolidation evaluation. RESULTS: According to post-operative measurements, group 1 showed a significant improvement in the scapholunate angle (p = 0.011) and in the intrascaphoid angle (p = 0.002). Group 2 only showed an improvement in the scapholunate angle (p = 0.011). All patients in group 1 achieved consolidation in 8 weeks, while group 2 patients had a slower consolidation, with a mean of 14 weeks and standard deviation (SD) of 4.2, with statistical significance (p = 0.006). CONCLUSION: Our prospective study, despite the limitations, contributes to the literature for demonstrating a better fixation using plate, with a better correction of humpback deformity and Dorsal Intercalated Segment Instability (DISI) and a faster consolidation. LEVEL OF EVIDENCE: II, therapeutics studies; prospective comparative study.

[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.

Luxación medial y plantar del hueso navicular asociada a fractura-subluxación calcaneocuboidea. Presentación de un caso / Medial and plantar dislocation of the navicular bone associated with a calcaneocuboid fracture-subluxation. Case report

Las luxaciones del escafoides aisladas y sin fractura son poco frecuentes. Por lo general, se presentan asociadas a fracturas del escafoides o a diversos patrones de lesión de la columna lateral. Presentamos el caso de un paciente con luxación medial y plantar del hueso navicular y fractura conminuta del proceso anterior del calcáneo y subluxación calcaneocuboidea. En el Servicio de Urgencia, se procedió a la reducción cerrada y la estabilización con agujas de Kirschner y, como tratamiento diferido, se colocaron placas en puente astragalonaviculo-cuneiforme y calcaneocuboidea de 2,0 mm, en forma transitoria, y el material de osteosíntesis se retiró a los 5 meses. El puntaje de la escala de la AOFAS fue excelente al año de seguimiento. Conclusiones: Es necesario llegar a un diagnóstico adecuado descartando lesiones de la columna lateral y reducir esta lesión en la atención de urgencia. La estabilización con placas en puente es una opción válida que podría evitar la pérdida de la reducción que se observa al retirar los clavos de Kirschner y permite una carga precoz. Nivel de Evidencia: IV

Isolated navicular dislocations are unusual. They are frequently associated with navicular fractures or diverse patterns of lateral column injuries. We report a case of a patient with medial and plantar navicular dislocation with a comminuted intra-articular fracture of the anterior process of the calcaneus and associated subluxation at the calcaneocuboid joint. The patient underwent closed reduction and Kirschner wire stabilization in the Emergency Service. As part of the deferred treatment, talonavicular-cuneiform and calcaneocuboid 2.0 mm bridge plates were temporarily placed and osteosynthesis material was removed 5 months later. The AO-FAS score was excellent in the one-year follow-up. Conclusion: An accurate diagnosis, ruling out lateral column injuries, should be done in the Emergency Service. Bridge plate stabilization is a valid option to prevent loss of reduction, which is observed when removing Kirschner wires, allowing early weight-bearing. Level of Evidence: IV

WALANT Technique in Percutaneous Scaphoid Osteosynthesis / WALANT na osteossíntese percutânea do escafoide

Abstract Scaphoid fractures account for 50 to 70% of all carpal bone fractures. Percutaneous scaphoid osteosynthesis can use the dorsal or volar approach, both with good results, and is most commonly performed under general anesthesia or regional nerve block. The wide-awake local anesthesia no tourniquet (WALANT) technique is already considered a safe and cost-effective technique in hand surgery around the world. Local anesthesia with epinephrine causes vasoconstriction, which obviates the need for tourniquet and, consequently, the need to use patient sedation. Thus, the possibility of testing fixation stability under physiological forces is another great advantage of using local anesthesia. In the technique described in the present paper, active wrist and hand motion can be tested immediately after scaphoid fixation. Wide-awake local anesthesia no tourniquet has been increasingly used in soft-tissue hand surgery and in the fixation of metacarpal and phalangeal fractures. However, to date, there is no published literature addressing the use of this technique in percutaneous scaphoid osteosynthesis. The purpose of the present technical note is to describe the use of WALANT for both the dorsal and volar approaches in percutaneous scaphoid osteosynthesis.

Resumo As fraturas do escafoide representam entre 50 e 70% de todas as fraturas dos ossos do carpo. A osteossíntese percutânea do escafoide pode usar a abordagem dorsal ou volar, ambas com bons resultados. É mais comumente realizada sob anestesia geral ou bloqueio nervoso regional. A técnica de anestesia local com o paciente totalmente acordado e sem torniquete (WALANT, na sigla em inglês) já é considerada uma técnica segura e eficaz na cirurgia da mão. A anestesia local com epinefrina causa vasoconstrição, o que evita o uso de torniquete e, consequentemente, a necessidade de sedação do paciente. Assim, a possibilidade de testar a estabilidade da fixação sob forças fisiológicas é outra grande vantagem do uso da anestesia local. Na técnica descrita aqui, o movimento ativo do punho e da mão pode ser testado imediatamente após a fixação escafoide. A técnica WALANT tem sido cada vez mais utilizada na cirurgia da mão em partes moles e na fixação de fraturas de metacarpo e falanges. No entanto, até o momento, não há literatura publicada abordando o uso dessa técnica na osteossíntese percutânea do escafoide. O objetivo desta nota técnica é descrever o uso de WALANT tanto para a abordagem dorsal quanto volar na osteossíntese percutânea do escafoide.

Percutaneous Grafting and Screw Fixation in Patients with Scaphoid Nonunion / Enxerto percutâneo e fixação de parafusos em pacientes com não consolidação do escafoide

Abstract Objective The aim of the present study was to analyze the clinical and radiological results of patients with type-V cystic scaphoid nonunion who were treated with percutaneous grafting and screw. Methods A total of 11 patients were treated with a percutaneous bone graft with screw fixation. The criteria for inclusion in the study were a type-V scaphoid nonunion and age > 18 years old. Those with humpback deformity, arthritis, ligament damage determined on magnetic resonance imaging, or avascular necrosis (AVN) in the nonunion fragment were excluded from the study. Results The mean follow-up time was 36 months (range: 15-53 months). At the final follow-up examination, the mean visual analogue scale score was 1.06 (range: 0-2.3). Postoperatively, the mean extension was 61.6° (44-80°), flexion 66° (60-80°), radial deviation 12° (7-20°), and ulnar deviation 25° (20-34°). The mean grip strength of the operated hand was found to be 94%, compared with the healthy side. The results obtained in the Mayo Modified Wrist Score were poor in 2 patients, good in 2 and excellent in 7 (64%). With the exception of 2 patients, union was obtained radiologically in 9 patients, with a mean of 12.6 weeks (range, 8-16 weeks). Conclusion Percutaneous grafting and screw fixation cannot replace open surgery in cases with deformity, shortening, humpbacking, or in long term nonunions; however, it is a reliable and effective treatment method in selected cases, such as Slade & Dodds type-V cystic nonunion.

Resumo Objetivo O objetivo do presente estudo foi analisar os resultados clínicos e radiológicos de pacientes com não consolidação do escafoide que foram tratados com enxerto percutâneo e parafuso. Métodos Um total de 11 pacientes foram tratados com enxerto ósseo percutâneo com fixação de parafuso. Os critérios de inclusão no estudo foram não consolidação do escafoide do tipo 5 e idade > 18 anos. Foram excluídos do estudo aqueles com deformidade corcunda, artrite, dano ligamentar determinado por ressonância magné- tica ou necrose avascular (NAV) no fragmento de não consolidação. Resultados O tempo médio de seguimento foi de 36 meses (intervalo: 15-53 meses). No exame final de seguimento, o escore médio de escala visual analógica foi de 1,06 (intervalo: 0-2,3). No pós-operatório, a extensão média foi de 61,6° (44-80°), flexão 66° (60-80°), desvio radial 12° (7--20°) e desvio ulnar 25° (20-34°). A força média de aderência da mão operada foi de 94% em comparação com o lado saudável. Os resultados obtidos no Mayo Modified Wrist Score foram ruins em 2 pacientes, bons em 2 e excelentes em 7 (64%). Com exceção de 2 pacientes, a consolidação foi confirmada radiologicamente em 9 pacientes com média de 12,6 semanas (intervalo: 8-16 semanas). Conclusão Enxerto percutâneoe fixação de parafusos não podem substituir a cirurgia aberta em casos de deformidade, encurtamento ou acorcundamento ou em não consolidação a longo prazo; no entanto, é um método de tratamento confiável e eficaz em casos selecionados, tais como a não consolidação do tipo V de Slade e Dodds.

[Treatment for non-union scaphoid fractures with headless cannulated screws and distal radius cancellous autograft]. / Tratamiento de no unión de fractura de escafoides con tornillos canulados sin cabeza e injerto autólogo esponjoso de radio distal.

INTRODUCTION: scaphoid fractures comprise 50-80% of the fractures of the carpal bones. Ten percent of the scaphoid fractures evolve to non-union and show degenerative changes in the carpus in 75-97% at five years and in 100% at 10 years. The objective of this work was to evaluate the rate and time to union in patients with diagnosis of scaphoid non-union without fragmentation of the proximal pole after treatment with two cannulated headless screws and distal radius cancellous autograft. MATERIAL AND METHODS: case series with short-term follow-up of four patients with scaphoid non-union without fragmentation of the proximal pole treated by internal fixation using two cannulated headless screws and distal radius cancellous bone autograft. All received the same postoperative treatment and radiographic control was taken as soon as the patient experienced clinical resolution. RESULTS: the radiographic union rate was 100% with an average time to union of 11.25 ± 3.4 weeks. There were no complications and revision surgery was not necessary. CONCLUSION: the results of the use of two cannulated headless screws and distal radius cancellous bone autograft endorses the technique as an effective and safe option for the treatment of scaphoid non-union without fragmentation of the proximal pole.

INTRODUCCIÓN: las fracturas de escafoides representan 50-80% de las fracturas de los huesos del carpo. De las fracturas de escafoides 10% evolucionan a no unión con tratamiento conservador y presentan cambios degenerativos en el carpo en 75-97% a cinco años y en 100% a 10 años. El objetivo de este trabajo fue evaluar la tasa y tiempo de consolidación en pacientes con diagnóstico de no unión de fractura de escafoides, sin fragmentación del polo proximal, tras tratamiento con dos tornillos canulados sin cabeza e injerto autólogo esponjoso de radio distal. MATERIAL Y MÉTODOS: serie de casos de cuatro pacientes con diagnóstico de no unión de fractura de escafoides sin fragmentación del polo proximal, tratados mediante reducción abierta y fijación interna utilizando dos tornillos canulados sin cabeza y toma más aplicación de autoinjerto esponjoso de radio distal. Todos recibieron el mismo tratamiento postoperatorio y se tomó control radiográfico para evidenciar consolidación una vez que el paciente experimentó resolución clínica. RESULTADOS: la tasa de consolidación radiográfica fue de 100% con un tiempo de consolidación promedio de 11.25 ± 3.4 semanas. No presentaron complicaciones y no fue necesaria una cirugía de revisión. CONCLUSIÓN: el resultado del uso de dos tornillos canulados sin cabeza y toma más aplicación de autoinjerto óseo esponjoso de radio distal avala la técnica como una opción efectiva y segura para el tratamiento de no unión de fracturas de escafoides sin fragmentación del polo proximal.

A Rare Presentation of Extensor Pollicis Longus Tendon Rupture After Nondisplaced Scaphoid Fracture.

Extensor pollicis longus tendon rupture is a reported complication after nondisplaced distal radius fractures. These are thought to occur secondary to mechanical irritation or compromised blood supply. We present a case of extensor pollicis longus rupture after a healed nondisplaced scaphoid fracture, which may have involved a similar attritional process. We are unaware of any prior reports of extensor pollicis longus rupture after this type of injury.