Successful surgical management of a Salter-Harris type I fracture of the accessory carpal bone in a dog.

OBJECTIVE: To describe the successful surgical management of a previously unreported Salter-Harris type I fracture of the accessory carpal bone in a dog. ANIMAL: An 11-week-old intact female Golden Retriever-Poodle cross presented with a history of a marked left forelimb lameness following a suspected fall from a height. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: On physical examination, the patient demonstrated a severe left forelimb lameness and pain on palpation and range of motion of the left carpus. Orthogonal radiographs of the distal left forelimb demonstrated a type I Salter-Harris fracture of the accessory carpal bone with proximal displacement of the palmar fragment. TREATMENT AND OUTCOME: The patient underwent open reduction and internal fixation wherein the fracture was reduced and stabilized with two 1.1-mm Kirschner wires. Postoperatively, the patient was initially managed with a carpal flexion bandage for 2 weeks and then a soft padded bandage was maintained until 4 weeks postoperatively. The patient recovered well and was walking and weight-bearing comfortably following removal of the carpal flexion bandage. Repeat radiographs performed 4 and 8 weeks postoperatively demonstrated adequate fracture healing but showed mild proximocaudal implant displacement. Implant removal was not performed, as the patient was doing well at home and the implant migration appeared static and was not causing clinical morbidity. CLINICAL RELEVANCE: To the authors' knowledge, this was the only reported case of a Salter-Harris fracture of the accessory carpal bone in a dog and the only described case of successful surgical stabilization.

A Case for Acute Proximal Row Carpectomy for Perilunate Injuries.

Background: Perilunate injuries are complex injuries typically arising from high-energy injuries to the wrist. Standard treatment involves open reduction and internal fixation with ligamentous reconstruction; however, outcomes are fraught with complications including pain, stiffness, and arthrosis. Several case reports have demonstrated the role of proximal row carpectomy as a salvage procedure for complex carpal trauma in the setting of significant cartilage injury or bone loss. The authors believe that proximal row carpectomy may be an appropriate acute treatment in certain patient populations, with functional results similar to those obtained with ligamentous reconstruction. Methods: A retrospective review of two cases with perilunate dislocations managed with primary proximal row carpectomy are presented. Results: At greater than 1-year follow-up, both patients had stable radiocarpal alignment. Quick-DASH scores were 22.7 and 27.3. Conclusion: Primary proximal row carpectomy is a treatment option in the acute setting for perilunate injuries in elderly, lower-demand patients. Functional results are similar to those obtained with ligamentous reconstruction, with a shorter recovery period. Level of Evidence: IV.

Isolated distal pisiform dislocation: Case Report / Luxação distal isolada do pisiforme: Relato de caso

Abstract Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction.

Resumo A luxação isolada do pisiforme é uma lesão rara com poucos casos descritos na literatura. Esse tipo de lesão é observado tipicamente em adultos jovens do sexo masculino e pode ser facilmente negligenciada numa primeira avaliação. A luxação proximal isolada é mais comum devido à ação do flexor ulnar do carpo (FUC). Apresentamos o caso de um paciente do sexo masculino, com 19 anos de idade, com luxação distal isolada do pisiforme após traumatismo do punho. O paciente foi submetido a uma redução aberta e fixação interna com fios de Kirschner com excelente resultado funcional. Apesar de não existir um método de tratamento consensual, a redução fechada perfila-se como tratamento de primeira linha na apresentação aguda. Em caso de insucesso ou como método alternativo pode-se optar pela redução aberta ou a excisão do pisiforme.

Diagnostic Failure Rate in Detecting Perilunate Carpal Fractures and Dislocations Using Plain Wrist X-Rays / Índice de falha diagnóstica na detecção de fraturas e luxações perilunares do carpo utilizando radiografias simples do punho

Abstract Objectives The present study aimed to evaluate the diagnostic failure rate in detecting perilunate fractures and dislocations using plain wrist radiographs by orthopedists and orthopedic residents. A secondary objective was to identify possible groups with a greater or lesser chance of establishing a correct diagnosis. Methods An online questionnaire was sent to several orthopedists through e-mail, social networks, and smartphone-based communication applications to assess the rate of diagnostic failure in detecting perilunate fractures and dislocations using plain radiographs. Results A total of 511 responses was obtained, with a diagnostic error rate of 8.81% for simple dislocations and 1.76% for trans-scaphoid perilunate fractures. Group stratification showed that residents presented the highest error rates in simple perilunate dislocations (23.91%), whereas hand surgeons presented the lowest error rates (1.74%). Conclusion Compared with the literature, the failure rates found were lower, suggesting that plain radiography is effective and that the error rate may not be as high as reported.

Resumo Objetivos O presente estude teve como objetivo avaliar o índice de falha diagnóstica na detecção de fraturas e luxações perilunares do carpo utilizando radiografias simples do punho por ortopedistas e residentes de ortopedia. Secundariamente, identificar possíveis grupos que apresentem maior ou menor chance de acerto diagnóstico. Métodos Foi aplicado um questionário online a diversos ortopedistas através de e-mail, redes sociais e aplicativos de comunicação via smartphone, para avaliar o índice de falha diagnóstica na detecção de fraturas e luxações perilunares utilizando radiografias simples. Resultados Foram obtidas 511 respostas e observado um índice de erro diagnóstico de 8,81% para as luxações simples e 1,76% para fratura transescafoperilunar. Ao estratificar por grupos, os médicos residentes obtiveram os maiores índices de erro nas luxações perilunares simples (23,91%), já os cirurgiões de mão obtiveram os índices mais baixos (1,74%). Conclusão Ao comparar com a literatura, os índices de falha encontrados foram menores, sugerindo que a radiografia simples é eficaz e que o índice de erro pode não ser tão elevado quanto o relatado na literatura.

Subluxação do tendão extensor ulnar do carpo em jogador de futebol amador: relato de caso de uma doença incomum / Subluxation of the extensor carpi ulnaris tendon in an amateur soccer player: case report of an unusual disease

O tendão extensor ulnar do carpo também apresenta importância na estabilidade da articulação radialulnar distal. A variância ulnar negativa pode ter uma associação com a patologia do tendão extensor ulnar do carpo, incluindo a subluxação. A subluxação/luxação do tendão extensor ulnar do carpo é observada em atletas, especialmente jogadores de tênis e golfistas, no lado dominante. Segundo Sole e col., 42% dos jogadores de tênis recreativos têm o tendão extensor ulnar do carpo instável (subluxação ou luxação). As lesões traumáticas no tendão extensor ulnar do carpo que resultam em luxação ou subluxação são raras na literatura. Contudo, elas podem ser mais comuns do que se supõe, pois geralmente são diagnosticadas erroneamente, resultando em subluxação recidivante e tratamento tardio (AU)

The extensor carpi ulnaris tendon shows the importance in the stability of the distal radial-ulnar joint. A negative ulnar variance may have an association with extensor carpi ulnaris tendon pathology, including subluxation. Subluxation / dislocation of the extensor carpi ulnaris tendon is observed in athletes, especially tennis players and golfers, on the dominant side. According to Sole et al., 42% of recreational tennis players have unstable extensor carpi ulnaris tendon (subluxation or dislocation). Traumatic injuries to the extensor carpi ulnaris tendon that result in dislocation or subluxation are rare in the literature. However, they may be more common than supposed because they are often misdiagnosed, resulting in relapsing subluxation and delayed treatment (AU)

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

Transtriquetral perihamate fracture-dislocation: case report / Fratura-luxação transtriquetral peri-hamato: relato de caso

ABSTRACT The wrist is a region that is very vulnerable to injuries of the extremities. Among these injuries, fractures of the pyramidal bone (or triquetrum) in association with dislocation of the hamate and carpal instability are uncommon. They are generally correlated with high-energy trauma and may be associated with neurovascular deficits, muscle-tendon disorders, skin lesions or injuries to other carpal bones. Thus, in this report, one of these rare cases of transtriquetral perihamate fracture-dislocation with carpal instability is presented, diagnosed by means of radiography on the right wrist of the patient who presented pain, edema and limitation of flexion-extension of the carpus after trauma to the region. The stages of attending to the case are described, from the initial consultation to the surgical treatment and physiotherapy, which culminated in restoration of the strength and range of motion of the wrist.

RESUMO O punho é uma região muito vulnerável a traumas de extremidade. Entre tais lesões, as fraturas do piramidal (ou triquetrum), associadas à luxação do hamato e à instabilidade carpal, são pouco frequentes. Geralmente relacionadas a traumatismos de alta energia, podem estar associadas a déficit neurovascular, miotendíneo, lesões de pele ou em outros ossos do carpo. Assim, neste relato, apresenta-se um desses casos raros de fratura-luxação transtriquetral peri-hamato com instabilidade carpal, diagnosticadas por radiografias do punho direito de um paciente que apresentava dor, edema e limitação da flexoextensão do carpo após trauma na região. As etapas do atendimento foram descritas desde a consulta inicial até o tratamento cirúrgico e a fisioterapia, que culminaram com a restauração da força e da amplitude de movimento do punho.

Doctor, me duelen las muñecas / Doctor, my wrists hurt

Presentamos el caso de una mujer de 40 años con dolor en ambas muñecas que aparece de forma progresiva y de meses de evolución. Se acompaña de parestesias, probablemente por atrapamiento del nervio mediano. Un adecuado diagnóstico diferencial incluye las patología congénitas y adquiridas. Tras la exploración física y hallazgos radiológicos se llega al juicio clínico final (AU)

We present the case of a 40 year-old woman with progressive pain in both wrists of months of evolution, and accompanied by paresthesia, probably due to median nerve entrapment. An appropriate differential diagnosis includes both congenital and acquired pathologies. Final diagnosis is reached after physical examination and radiological findings (AU)

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.

Carpal Bone Fractures in Distal Radial Fractures: Is Computed Tomography Expedient?

No abstract available.

Luxación palmar del escafoides carpiano asociado a una luxación perilunar dorsal. A propósito de un caso y revisión de la bibliografía / Palmar scaphoid dislocation associated with dorsal perilunate dislocation. A case report and review of the literature

La mayoría de las luxaciones del carpo ocurren en el semilunar o a su alrededor (perilunar). La luxación aislada del escafoides carpiano es una entidad rara. Presentamos un caso clínico de luxación palmar del escafoides asociada con una luxación perilunar dorsal, tratado con reducción abierta, y estabilizado con 2 agujas de Kirschner y reparación ligamentosa, con buen resultado (AU)

Most carpal dislocations occur in the lunate bone or around it (perilunate). An isolated dislocation of the carpal scaphoid is a rare injury. We report a case of a palmar scaphoid dislocation combined with a dorsal perilunate dislocation, which was treated with open reduction, fixed with two Kirschner wires and ligament repair, with a good result (AU)

Evaluation of Associated Carpal Bone Fractures in Distal Radial Fractures

BACKGROUND: The purpose of this study was to investigate the frequency and distribution of associated carpal bone fractures (CBFs) in distal radial fractures (DRFs). METHODS: Three hundred and thirteen patients who underwent surgical treatment for DRFs between March 2007 and January 2010 were reviewed retrospectively. In this study, 223 patients who had preoperative computed tomography (CT) were included. We investigated the frequency and distribution of associated CBFs on CT scans. The relationship between the frequency of associated CBFs and patient factors such as age, gender, body mass index, and the mechanism of injury was assessed. RESULTS: CBFs were complicated in 46 of 223 DRFs (20.9%). The distribution of CBFs was 23 cases in the triquetrum, 16 in the lunate, 12 in the scaphoid, five in the hamate, and four in the pisiform. Among the 46 cases, a fracture of one carpal bone occurred in 36 cases, two in seven cases, three in two cases, and four in one case. In 10 of the 46 cases, associated CBFs occurred in more than two carpal bones. No significant differences were observed for age, sex, body mass index, or the mechanism of injury between patients with DRFs and CBFs and those without CBFs. CONCLUSIONS: Because CBFs that mainly occur in the proximal carpal row are complicated in DRFs at a relatively high frequency, assessment of carpal bones using CT scans is beneficial.

Fracturas-luxaciones del carpo: resultados radiológicos y funcionales después del tratamiento quirúrgico / Carpal fracture-dislocations: radiologic and functional outcomes after surgical treatment

Introducción: Las luxaciones y fracturas-luxaciones traumáticas del carpo son lesiones potencialmente devastadoras, con frecuencia diagnosticadas tardíamente. El objetivo de este trabajo es evaluar los resultados radiográficos y funcionales obtenidos luego del tratamiento quirúrgico de estas lesiones. Materiales y métodos: Se evaluaron en forma retrospectiva, entre 2004 y 2010, 27 pacientes con diferentes tipos de luxaciones y fracturas-luxaciones del carpo, con una edad promedio de 28 años. Once lesiones fueron agudas, 11 subagudas y 5 crónicas. Se evaluaron 5 luxaciones perilunares, una luxación mediocarpiana y 21 fracturas luxaciones perilunares. Resultados: El seguimiento promedió 14 meses. El ángulo del carpo promedió 130º, el ángulo escafolunar promedió 46º, el ángulo grandesemilunar promedió 23°, la altura del carpo promedió 1,56 y el espacio escafolunar promedió 1,5 mm. Los resultados funcionales promedio fueron: flexión 60°, extensión 43º, desviación cubital 16º, desviación radial 17º, pronación 77°, supinación 72º. Los resultados promedio al realizar las pruebas de fuerza fueron: dinamómetro 27 kg, digitómetro prueba pinza llave 9 kg y pinza tridigital 7 kg. La escala de DASH promedió 33 puntos. La escala analógica del dolor promedió 6,5 puntos. Conclusión: Hay muchos aspectos de estas lesiones poco estudiados o, incluso, que se desconocen. Estas lesiones deben tratarse de forma temprana para optimizar los resultados mediante un tratamiento quirúrgico agudo que permita una óptima reducción ósea y reparación ligamentaria utilizando, si es necesario, un doble abordaje (AU)

Fracturas-luxaciones del carpo: resultados radiológicos y funcionales después del tratamiento quirúrgico / Carpal fracture-dislocations: radiologic and functional outcomes after surgical treatment

Introducción: Las luxaciones y fracturas-luxaciones traumáticas del carpo son lesiones potencialmente devastadoras, con frecuencia diagnosticadas tardíamente. El objetivo de este trabajo es evaluar los resultados radiográficos y funcionales obtenidos luego del tratamiento quirúrgico de estas lesiones. Materiales y métodos: Se evaluaron en forma retrospectiva, entre 2004 y 2010, 27 pacientes con diferentes tipos de luxaciones y fracturas-luxaciones del carpo, con una edad promedio de 28 años. Once lesiones fueron agudas, 11 subagudas y 5 crónicas. Se evaluaron 5 luxaciones perilunares, una luxación mediocarpiana y 21 fracturas luxaciones perilunares. Resultados: El seguimiento promedió 14 meses. El ángulo del carpo promedió 130º, el ángulo escafolunar promedió 46º, el ángulo grandesemilunar promedió 23°, la altura del carpo promedió 1,56 y el espacio escafolunar promedió 1,5 mm. Los resultados funcionales promedio fueron: flexión 60°, extensión 43º, desviación cubital 16º, desviación radial 17º, pronación 77°, supinación 72º. Los resultados promedio al realizar las pruebas de fuerza fueron: dinamómetro 27 kg, digitómetro prueba pinza llave 9 kg y pinza tridigital 7 kg. La escala de DASH promedió 33 puntos. La escala analógica del dolor promedió 6,5 puntos. Conclusión: Hay muchos aspectos de estas lesiones poco estudiados o, incluso, que se desconocen. Estas lesiones deben tratarse de forma temprana para optimizar los resultados mediante un tratamiento quirúrgico agudo que permita una óptima reducción ósea y reparación ligamentaria utilizando, si es necesario, un doble abordaje (AU)

Fracturas-luxaciones del carpo: resultados radiológicos y funcionales después del tratamiento quirúrgico / Carpal fracture-dislocations: radiologic and functional outcomes after surgical treatment

Introducción: Las luxaciones y fracturas-luxaciones traumáticas del carpo son lesiones potencialmente devastadoras, con frecuencia diagnosticadas tardíamente. El objetivo de este trabajo es evaluar los resultados radiográficos y funcionales obtenidos luego del tratamiento quirúrgico de estas lesiones. Materiales y métodos: Se evaluaron en forma retrospectiva, entre 2004 y 2010, 27 pacientes con diferentes tipos de luxaciones y fracturas-luxaciones del carpo, con una edad promedio de 28 años. Once lesiones fueron agudas, 11 subagudas y 5 crónicas. Se evaluaron 5 luxaciones perilunares, una luxación mediocarpiana y 21 fracturas luxaciones perilunares. Resultados: El seguimiento promedió 14 meses. El ángulo del carpo promedió 130º, el ángulo escafolunar promedió 46º, el ángulo grandesemilunar promedió 23°, la altura del carpo promedió 1,56 y el espacio escafolunar promedió 1,5 mm. Los resultados funcionales promedio fueron: flexión 60°, extensión 43º, desviación cubital 16º, desviación radial 17º, pronación 77°, supinación 72º. Los resultados promedio al realizar las pruebas de fuerza fueron: dinamómetro 27 kg, digitómetro prueba pinza llave 9 kg y pinza tridigital 7 kg. La escala de DASH promedió 33 puntos. La escala analógica del dolor promedió 6,5 puntos. Conclusión: Hay muchos aspectos de estas lesiones poco estudiados o, incluso, que se desconocen. Estas lesiones deben tratarse de forma temprana para optimizar los resultados mediante un tratamiento quirúrgico agudo que permita una óptima reducción ósea y reparación ligamentaria utilizando, si es necesario, un doble abordaje

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.

Luxaciones y fracturas-luxaciones perilunares del carpo / Perilunate carpal dislocations and fracturedislocations

Introducción. Las luxaciones y fracturas-luxaciones perilunares del carpo son lesiones mucho menos frecuentes que las fracturas de radio distal; sin embargo, son unas lesiones graves que puede alterar definitivamente la biomecánica de la muñeca, debido a algunas lesiones irreparables que se producen y a la dificultad de su tratamiento. Lo más importantees hacer un diagnóstico temprano de todas las estructurasafectadas (óseas, cartilaginosas y ligamentosas) y, paraello, además de la radiología convencional de la muñeca,será de gran utilidad la radiografía realizada en tracción continua. Es importante saber que las lesiones óseas no descartan la existencia de lesiones ligamentosas asociadas. La fractura de escafoides se asocia algunas veces a rotura del ligamento escafo-lunar.Tratamiento. Nunca se debe comenzar el tratamiento sinhaber clasificado la lesión según los criterios de Larsen et al en los que hay que evaluar: antigüedad, persistencia, etiología, localización anatómica, dirección y tipo o modelo de inestabilidad. Los criterios actuales se inclinan por el tratamientoquirúrgico mediante abordaje dorsal, palmar o doble,según lo requiera la lesión. Las técnicas incluyen suturao reinserciones ligamentosas, osteosíntesis preferiblemente con tornillo a compresión en el escafoides y agujas de K en el resto de las fracturas. Habrá que utilizar también agujas de K entre los diferentes huesos para que se mantengan lasrelaciones de reducción anatómica entre ellos en el tiempo en que curan las lesiones ligamentosas (8 a 12 semanas). Sólo unos pocos casos muy especiales de fracturas-luxaciones transescafoperilunares pueden ser susceptibles de hacer tratamiento conservador. La reducción anatómica de estas lesiones no garantiza un resultado final perfecto, aunque los resultados generales publicados en las series más representativasse relacionan directamente con el grado de reducción,mantenida durante el período de consolidación, que se haya conseguido. El resultado clínico suele ser mejor que el radiográfico, aunque en general no se supera el 50% de resultados buenos y excelentes. Las condiciones de la lesión parece que influyen tanto o más en el resultado que el tratamiento realizado.Conclusiones. La inestabilidad carpiana, las pseudoartrosis del escafoides y la artrosis postraumática radiocarpiana e intercarpianason complicaciones que afectan a más del 50%de los pacientes que han padecido estas lesiones, aunque hayan sido tratados en servicios especializados. Esto quiere decir que se debe seguir investigando en nuevas formas de tratamiento por parte del cirujano ortopédico y del médico rehabilitador

Introduction. Although the incidence of perilunate carpaldislocations and fracture-dislocations is much lower thanthat of distal radial fractures, their severity is much more significant since they are extremely difficult to treat and they could irreparably alter wrist biomechanics. It is essential to perform an early diagnosis of all involved structures (bone, chondral and ligamentous). For this reason, in additionto conventional films, it is very useful to carry out continuous traction radiographs. One should bear in mind that bone injury does not rule out the existence of associated ligament lesions. Scaphoid fractures are sometimes associated to scapholunate ligament tears.Treatment. Treatment should never be started without having classified the injury according to the criteria laid down by Larsen et al, according to which an assessment must be made of: time of progression, persistence, etiology, anatomical location, direction, and instability type or model. Current practice tends to favor surgical treatment by means of a dorsal, palmar or dual approach, as appropriate. Additional indications include suturing and ligament reattachmentsand osteosynthesis preferably with compression screws inthe scaphoid and K-wires in the remaining fractures. K-wires must also be used between the different bones so that anatomical reduction relations are preserved between as ligamentous injuries heal (8 to 12 weeks). Only very few special trans-scaphoid-lunate fracture dislocations are eligible for nonsurgical treatment. Anatomical reduction of these injuriesdoes not guarantee a perfect final result, but the results published in the most representative series are directly related to the degree of reduction achieved. Clinical results tend to outperform radiological results, but in general good and excellent results evaluated together do not exceed 50% of the total. The characteristics of the lesion seem to havean equal or higher influence on the result, rather than the treatment applied.Conclusions. Carpal instability, scaphoid nonunion and radiocarpal and intercarpal post-traumatic osteoarthritis are complications affecting over 50% of patients who have sustained these lesions, even if they were treated in specialized units. This means that further research is needed as new typesof treatment that can be administered both by the orthopedic surgeon and the rehabilitation physician

Fracturas del trapecio: clasificación, diagnóstico y tratamiento / Trapezial fractures: classification, diagnosis and treatment

Objetivo. Revisión de la etiología, clasificación, diagnóstico y tratamiento de las fracturas de trapecio.Material y método. Revisión bibliográfica y experiencia del autor.Conclusiones. Las fracturas del trapecio presentan una baja incidencia, por lo que su diagnóstico puede pasar desapercibido. El diagnóstico se basa en la exploración y estudio de imagen, con proyecciones radiológicas apropiadas (incluyendo la tomografía axial). El tratamiento puede ser ortopédico en las fracturas del cuerpo no estables con una incongruencia articular inferior a 1 mm; la excisión de fragmentosestaría indicada en aquellas fracturas parcelares delcuerpo y el tipo II de la cresta; la osteosíntesis se indicará en fracturas del cuerpo inestables, con una incongruencia articular mayor de 1 mm o una diastasis mayor de 2 mm. El resultado del tratamiento suele ser satisfactorio, mientras que si la fractura pasa desapercibida puede desembocar ensecuelas como rizartrosis, pseudoartrosis dolorosa o tendinopatía

Purpose. To review the etiology, classification, diagnosis and treatment of trapezial fractures.Materials and methods. Review of the literature and ananalysis of the authors’ experience.Conclusions. Trapezial fractures have a low incidence andthey may even go undiagnosed. Diagnosis is based on anexamination of the patient and a series of imaging studies including a CT-scan. Treatment of not unstable trapezial body fractures with an articular incongruence of less than 1 mm may be treated conservately for comminuted trapezial body fractures or type II crest fractures fragment excision may be indicated; and osteosynthesis should be reserved for instable body fractures with incongruency higher than 1 mmor a gap wider than 2 mm. The result of treatment tends to be satisfactory. However, if the fracture goes undetected it can result in sequelae like rizarthrosis, painful nonunion or tendinopathy

Fracturas y pseudoartrosis del escafoides carpiano / Fractures and nonunions of the carpal

Introducción. Las fracturas del escafoides carpiano siguen siendo un tema de interés, sobre todo cuando no consolidan (pseudoartrosis).Revisión de conceptos. En este artículo hemos realizadouna actualización de conceptos sobre las fracturas del escafoides carpiano, su diagnóstico, los tipos de fractura y su valor pronóstico, las consolidaciones parciales y su tratamiento. También sobre sus pseudoartrosis y su tratamiento.Conclusión. Disponemos cada vez de más medios diagnósticos y terapéuticos para el tratamiento exitoso de las fracturas y pseudoartrosis del escafoides carpiano

Introduction. Carpal scaphoid fractures are still a subject of interest especially when they do not heal (nonunion).Concept review. This paper presents a review of the latest concepts in carpal scaphoid fractures as regards to their diagnosis, the different fracture types and their prognostic value, malunions and their treatment, and nonunions and its treatment.Conclusion. We have an increasing number of diagnosticand therapeutic tools for the successful treatment of fractures and nonunions of the carpal scaphoid

Luxaciones y fracturas-luxaciones perilunares del carpo / Perilunate carpal dislocations and fracture-dislocations

Introducción. Las luxaciones y fracturas-luxaciones perilunares del carpo son lesiones mucho menos frecuentes que las fracturas de radio distal; sin embargo, son unas lesiones graves que puede alterar definitivamente la biomecánica dela muñeca, debido a algunas lesiones irreparables que seproducen y a la dificultad de su tratamiento. Lo más importante es hacer un diagnóstico temprano de todas las estructuras afectadas (óseas, cartilaginosas y ligamentosas) y, para ello, además de la radiología convencional de la muñeca, será de gran utilidad la radiografía realizada en traccióncontinua. Es importante saber que las lesiones óseas no descartan la existencia de lesiones ligamentosas asociadas. La fractura de escafoides se asocia algunas veces a rotura del ligamento escafo-lunar.Tratamiento. Nunca se debe comenzar el tratamiento sinhaber clasificado la lesión según los criterios de Larsen et al en los que hay que evaluar: antigüedad, persistencia, etiología, localización anatómica, dirección y tipo o modelo de inestabilidad. Los criterios actuales se inclinan por el tratamientoquirúrgico mediante abordaje dorsal, palmar o doble,según lo requiera la lesión. Las técnicas incluyen suturao reinserciones ligamentosas, osteosíntesis preferiblemente con tornillo a compresión en el escafoides y agujas de K en el resto de las fracturas. Habrá que utilizar también agujasde K entre los diferentes huesos para que se mantengan las relaciones de reducción anatómica entre ellos en el tiempo en que curan las lesiones ligamentosas (8 a 12 semanas). Sólo unos pocos casos muy especiales de fracturas-luxaciones transescafoperilunares pueden ser susceptibles de hacer tratamientoconservador. La reducción anatómica de estas lesionesno garantiza un resultado final perfecto, aunque losresultados generales publicados en las series más representativas se relacionan directamente con el grado de reducción, mantenida durante el período de consolidación, que se haya conseguido. El resultado clínico suele ser mejor que el radiográfico,aunque en general no se supera el 50% de resultadosbuenos y excelentes. Las condiciones de la lesión pareceque influyen tanto o más en el resultado que el tratamiento realizado.Conclusiones. La inestabilidad carpiana, las pseudoartrosis del escafoides y la artrosis postraumática radiocarpiana e intercarpianason complicaciones que afectan a más del 50%de los pacientes que han padecido estas lesiones, aunque hayan sido tratados en servicios especializados. Esto quiere decir que se debe seguir investigando en nuevas formas de tratamiento por parte del cirujano ortopédico y del médico rehabilitador

Introduction. Although the incidence of perilunate carpaldislocations and fracture-dislocations is much lower thanthat of distal radial fractures, their severity is much more significant since they are extremely difficult to treat and they could irreparably alter wrist biomechanics. It is essential to perform an early diagnosis of all involved structures (bone, chondral and ligamentous). For this reason, in additionto conventional films, it is very useful to carry out continuous traction radiographs. One should bear in mind that bone injury does not rule out the existence of associated ligament lesions. Scaphoid fractures are sometimes associated to scapholunate ligament tears.Treatment. Treatment should never be started without having classified the injury according to the criteria laid down by Larsen et al, according to which an assessment must be made of: time of progression, persistence, etiology, anatomicallocation, direction, and instability type or model. Current practice tends to favor surgical treatment by means of a dorsal, palmar or dual approach, as appropriate. Additional indications include suturing and ligament reattachments and osteosynthesis preferably with compression screws in the scaphoid and K-wires in the remaining fractures. K-wires must also be used between the different bones so thatanatomical reduction relations are preserved between as ligamentous injuries heal (8 to 12 weeks). Only very few special trans-scaphoid-lunate fracture dislocations are eligible for nonsurgical treatment. Anatomical reduction of these injuries does not guarantee a perfect final result, but the results published in the most representative series are directlyrelated to the degree of reduction achieved. Clinical results tend to outperform radiological results, but in general good and excellent results evaluated together do not exceed 50% of the total. The characteristics of the lesion seem to have an equal or higher influence on the result, rather than the treatment applied.Conclusions. Carpal instability, scaphoid nonunion and radiocarpal and intercarpal post-traumatic osteoarthritis are complications affecting over 50% of patients who have sustained these lesions, even if they were treated in specialized units. This means that further research is needed as new types of treatment that can be administered both by the orthopedicsurgeon and the rehabilitation physician