Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico / Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study

Antecedentes y objetivo: Las fracturas de falange proximal (FP) son las fracturas más frecuentes de la mano. En los últimos años, se ha descrito el uso de tornillos endomedulares sin cabeza (TESC) para las fracturas inestables transversas u oblicuas de la FP. A pesar de que tanto la técnica anterógrada como retrógrada con TESC han mostrado buenos resultados, no se ha publicado ningún estudio comparativo de su uso en fracturas de FP. Nuestro objetivo es determinar la estabilidad que se obtiene con el uso de TESC retrógrados y anterógrados en un modelo en cadáver de fractura transversa proximal de FP, a dos niveles diferentes. Material y métodos: Realizamos un estudio biomecánico en 30 modelos de fractura de FP de cadáver fresco-congelado. La osteotomía se realizó a los 9 mm desde la articulación metacarpofalángica (MCF) en 15 especímenes, y a una distancia de 15 mm en los otros 15. A su vez, en cada grupo, cinco osteotomías se estabilizaron con un TESC anterógrado intraarticular, cinco mediante un TESC anterógrado transarticular y cinco con un TESC retrógrado. Resultados: La fijación con TESC anterógrado en osteotomías realizadas a los 9 mm (tanto con la técnica transarticular como intraarticular, 62,74 N y 70,86 N, respectivamente) fue más estable que la fijación con TESC retrógrado (32,72 N) (p 0,022). Por otra parte, la fijación con TESC retrógrado fue más estable en el modelo de fractura más distal (90,52 N retrógrado vs. 57,64 N transarticular vs. 42,92 N intraarticular (p = 0,20). Conclusiones: La fijación con TESC retrógrado ofrece más estabilidad en fracturas más distales, mientras que las técnicas anterógradas son más estables en fracturas proximales.(AU)

Background and objective: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. Material and methods: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. Results: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). Conclusions: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.(AU)

[Translated article] Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study / Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico

Background and objective: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. Material and methods: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. Results: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). Conclusions: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.(AU)

Antecedentes y objetivo: Las fracturas de falange proximal (FP) son las fracturas más frecuentes de la mano. En los últimos años, se ha descrito el uso de tornillos endomedulares sin cabeza (TESC) para las fracturas inestables transversas u oblicuas de la FP. A pesar de que tanto la técnica anterógrada como retrógrada con TESC han mostrado buenos resultados, no se ha publicado ningún estudio comparativo de su uso en fracturas de FP. Nuestro objetivo es determinar la estabilidad que se obtiene con el uso de TESC retrógrados y anterógrados en un modelo en cadáver de fractura transversa proximal de FP, a dos niveles diferentes. Material y métodos: Realizamos un estudio biomecánico en 30 modelos de fractura de FP de cadáver fresco-congelado. La osteotomía se realizó a los 9 mm desde la articulación metacarpofalángica (MCF) en 15 especímenes, y a una distancia de 15 mm en los otros 15. A su vez, en cada grupo, cinco osteotomías se estabilizaron con un TESC anterógrado intraarticular, cinco mediante un TESC anterógrado transarticular y cinco con un TESC retrógrado. Resultados: La fijación con TESC anterógrado en osteotomías realizadas a los 9 mm (tanto con la técnica transarticular como intraarticular, 62,74 N y 70,86 N, respectivamente) fue más estable que la fijación con TESC retrógrado (32,72 N) (p 0,022). Por otra parte, la fijación con TESC retrógrado fue más estable en el modelo de fractura más distal (90,52 N retrógrado vs. 57,64 N transarticular vs. 42,92 N intraarticular (p = 0,20). Conclusiones: La fijación con TESC retrógrado ofrece más estabilidad en fracturas más distales, mientras que las técnicas anterógradas son más estables en fracturas proximales.(AU)

Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study. / Comparación de tres técnicas de tornillo endomedular mínimamente invasivo para fracturas de falange proximal. Estudio biomecánico.

BACKGROUND AND OBJECTIVE: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. MATERIAL AND METHODS: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15 mm in the other 15. In turn, in each group, five fractures were stabilized with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. RESULTS: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74 N and 70.86 N, respectively) was found to be more stable than retrograde IMHCS one (32.72 N) (p = 0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52 N retrograde vs. 57.64 N trans-articular vs. 42.92 N intra-articular; p = 0.20). CONCLUSIONS: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

[Translated article] Comparison of three different minimally invasive intramedullary screw for proximal phalanx fractures. A biomechanical study.

BACKGROUND AND OBJECTIVE: Phalangeal fractures are the most common hand fractures. In the last years, intramedullary compression screw (IMHCS) for instable transverse or short oblique proximal P1 fractures have been described. Although both anterograde (intraarticular or trans-articular) and retrograde IMHCS techniques have shown good results, no comparison between anterograde and retrograde screw in P1 fractures has been published. We sought to determine stability with retrograde IMHCS and anterograde IMHCS, both trans-articular and intra-articular technique, in a cadaveric transverse proximal P1 fracture model, at two different levels. MATERIAL AND METHODS: We performed a biomechanical study in 30 fresh-frozen human cadaveric P1 fracture model. Fracture was performed at 9-mm from the metacarpo-phalangeal (MCP) joint in 15 specimens, whereas it was done at 15mm in the other 15. In turn, in each group, five fractures were stabilised with an anterograde intra-articular IMHCS, five with anterograde trans-articular IMHCS and other five with retrograde IMHCS. RESULTS: Anterograde IMHCS fixation in 9-mm P1 fractures (both trans- and intra-articular technique, 62.74N and 70.86N, respectively) was found to be more stable than retrograde IMHCS one (32.72N) (p=0.022). Otherwise, retrograde IMHCS fixation was found to be more stable in more distal P1 fractures (90.52N retrograde vs. 57.64N trans-articular vs. 42.92N intra-articular; p=0.20). CONCLUSIONS: Anterograde IMHCS fixation in proximal transverse P1 bone cut in a cadaveric model provides more stability than retrograde IMHCS, while retrograde screw provides more stability when the bone cut is located more distal.

Strongyloides stercolaris infection mimicking a malignant tumour in a non-immunocompromised patient. Diagnosis by bronchoalveolar cytology.

Autoinfective strongyloidiasis is often fatal in immunosuppressed patients or in immunocomprised hosts. An interesting case of Strongyloides stercolaris hyperinfection was seen in an immunocompetent patient. This report describes a case of fatal strogyloidiasis in a 79 year old man, who had suffered gastrointestinal discomfort for years, and who presented because of respiratory illness. A chest radiograph showed an irregular mass close to the mediastinum and interstitial infiltrates, but blood eosinophilia was not observed. Cytological examination of the samples obtained from bronchial aspiration and brushing identified several filariform larvae. Thus, cytology was essential for the correct diagnosis in this patient and is a very reliable method to diagnose lung parasitosis.

Fine needle aspiration cytology of mammary hamartoma: a review of nine cases with histological correlation.

Mammary hamartoma is a breast lesion rarely reported by fine-needle aspiration cytology (FNAC). We report on our experience of FNAC in nine cases confirmed by biopsy. We searched hospital case files for mammary hamartoma or similar lesions (fibrolipomas, lipomas, fibromas, etc.), and cases included were only those in which both FNAC and a histopathological study had been performed. The cytological features that were analysed included epithelial components, mesenchymal fragments and isolated cells dispersed in the background. The patients ranged in age from 25 to 58 years (mean 40 years), and the lesions were predominantly in the right breast and upper outer quadrant. The duration varied from 1 to 20 years. Mammographic features were characteristic revealing well-circumscribed masses of heterogeneous radiodensity and by ultrasonography were hypoechoic without calcification. Grossly, these lesions were oval to round, well-demarcated masses, ranging in diameter from 10 to 80 mm. The tumours were firm, rubbery and white, consisting largely of dense fibroconnective tissue with variable amounts of adipose tissue and glandular elements. Cytological samples showed two components, epithelial and mesenchymal. The cellularity was variable and was composed of lobular cells forming acini, ductal cells, occasional apocrine and foamy cells; myoepithelial cells and isolated naked nuclei were also observed. Adipose tissue and dense fibrous tissue were observed, occasionally with epithelial cells attached, and this finding was an important feature for diagnosis. We considered that the cytological findings could help to diagnose mammary hamartoma, FNAC making a rapid and very important technique for the diagnosis of this pathology.