Radiographic evaluation of radial flexion osteotomy effect on static scapholunate instability: a preliminary cadaveric study.

INTRODUCTION: The optimal treatment of chronic scapholunate instability has yet to be established. Scapholunate ligament grafts are still far from being the ideal solution. We conducted an experimental study to evaluate whether flexion-opening wedge osteotomy of the distal radius improves misalignment and avoids rotatory subluxation of the scaphoid in a cadaveric model of static scapholunate dissociative instability. MATERIALS AND METHODS: Radiographic studies were performed on 15 cryopreserved specimens after recreating a model of scapholunate instability by division of the scapholunate interosseous ligament (SLIL) and secondary stabilizers, taking radiographs at baseline, after the instability model, and after distal radius osteotomy. Static and dynamic (under controlled tendon traction) anteroposterior and lateral views were obtained to measure the length (in mm) of the carpal scaphoid and scapholunate interval, scapholunate angle, radio-lunate angle, and palmar tilt of the distal joint surface of the radius and to measure the dorsal scaphoid translation by the concentric circles method. The Wilcoxon test was used for statistical comparisons. RESULTS: The scapholunate interval was significantly decreased after osteotomy in all static anteroposterior views and in all lateral views under tendon traction. Dorsal scaphoid translation was significantly reduced in static lateral view in extension and in dynamic lateral view under 5-pound flexor carpi radialis tendon tension controlled by a digital dynamometer. CONCLUSIONS: Flexion-addition osteotomy of the distal radius appears to improve carpal alignment parameters in a cadaveric model of static scapholunate instability, achieving similar values to those obtained before instability.

Cifoplastia percutánea con balón en el tratamiento de aplastamientos vertebrales. Evaluación en nuestro medio / Percutaneous balloon kyphoplasty in the treatment of vertebral collapse. Evaluation in our environment

Introducción: Las fracturas vertebrales representan un importante problema de salud en la población. Por grupos de edad, la etiología varía ampliamente, siendo los traumatismos toracolumbares de alta energía en el contexto de precipitaciones y accidentes de tráfico la causa más frecuente en pacientes jóvenes y de mediana edad, y los aplastamientos vertebrales secundarios a fracaso por estrés de hueso patológico la causa más habitual en edades avanzadas, siendo además el sustrato patológico vertebral más habitual la existencia de metástasis óseas, tumores primarios vertebrales, ó la concomitancia de osteoporosis, ostensiblemente más prevalente a medida que aumenta la edad en la población de estudio. La vertebroplastia y la cifoplastia con balón son técnicas percutáneas de mínima invasión, indicadas en el tratamiento de ciertas fracturas somáticas vertebrales, basadas en la introducción intrasomática de cemento (PMMA) ó sustitutos óseos. Objetivo: Presentamos una revisión de las fracturas vertebrales que fueron tratadas en nuestro centro mediante cifoplastia percutánea con balón, y un análisis de los resultados obtenidos de acuerdo con lo aceptado por la comunidad científica y la literatura en el momento actual. Conclusiones: La cifoplastia percutánea con balón es una técnica segura, fiable y recomendable según indicación, en el tratamiento de fracturas vertebrales, mejorando los resultados obtenidos mediante el tratamiento convencional (conservador vs. artrodesis instrumentada), reduciendo la morbilidad asociada por dolor, efecto cifosante y daño reumático y neurológico secundario a la progresión de deformidades, permitiendo al paciente la incorporación precoz a sus actividades cotidianas y a su ocupación laboral, con una tasa de complicaciones asumibles y el consiguiente ahorro para el sistema sociosanitario

Introduction: Vertebral fractures are a major health problem in the population. By age group, the etiology varies widely, with the thoracolumbar highenergy trauma in the context of rainfall and traffic accidents the most common in young and middleaged patients cause, and secondary to vertebral ompression failure stress of pathological bone the most common cause in old age, being also the most common spinal significantly more prevalent as the pathological substrate bone metastases, primary vertebral tumors, or the concomitant osteoporosis,increasing age in the study population. Vertebroplasty and kyphoplasty balloon are minimally invasive percutaneous techniques, indicated in the treatment of certain somatic vertebral fractures, based in the introduction of cement (PMMA) or bone substitutes into the vertebral body. Objective: We present a review of vertebral fractures who were treated in our hospital by percutaneous balloon kyphoplasty, and an analysis of the results obtained in accordance with accepted by the scientific community and the recent literature. Conclusions: Percutaneous balloon kyphoplasty is a safe , reliable and recommended technique as indicated in the treatment of vertebral fractures by improving the results obtained by the conventional treatment (conservative vs. instrumented arthrodesis), reducing the morbidity associated, pain, cifosis effect and secondary rheumatic and neurological damage to the progression of deformity , allowing the patient early incorporation into their daily activities and their occupation, with a rate of assumable complications and consequent savings for the social services system