Trapeziectomy With Ligament Reconstruction and Tendon Interposition Versus a Trapeziometacarpal Prosthesis for the Treatment of Thumb Basal Joint Osteoarthritis.

Numerous surgical procedures have been described to treat trapeziometacarpal osteoarthritis, but no approach is currently considered superior. Good long-term outcomes have been reported with multiple procedures. No studies have been published comparing outcomes of the Arpe joint replacement (Biomet, Valence, France) with those of ligament reconstruction and tendon interposition (LRTI) using the Burton-Pellegrini technique. The study objective was to compare clinical outcomes between these techniques. Sixty-five patients with Eaton stage III osteoarthritis of the thumb were included in this retrospective follow-up study. Patients were assigned to LRTI (LRTI group) or total joint replacement (Arpe group) and were followed for a mean of 4.8 years. The LRTI group included 34 patients and the Arpe group included 31. Clinical outcome variables were determined preoperatively and every 6 months postoperatively. Pain relief and functional improvement were similar between groups. Pinch strength and range of motion were superior in the Arpe group. Metacarpophalangeal hyperextension appeared to be prevented in the Arpe group but increased over the follow-up period in the LRTI group. However, the complication rate was higher in the Arpe group. Arthroplasty with the Arpe prosthesis can be considered in selected patients who require greater strength and range of motion, although it has been associated with a higher complications rate. [Orthopedics. 2017; 40(4):e681-e686.].

Ghrelin and adipose-derived mesenchymal stromal cells improve nerve regeneration in a rat model of epsilon-caprolactone conduit reconstruction.

OBJECTIVE: Attempts have been made to improve nerve conduits in peripheral nerve reconstruction. We investigated the potential therapeutic effect of adipose-derived mesenchymal cells (ASCs) and ghrelin (GHR), a neuropeptide with neuroprotective, trophic, and developmental regulatory actions, on peripheral nerve regeneration in a model of severe nerve injury repaired with nerve conduits. MATERIAL AND METHODS: The right sciatic nerves of 24 male Wistar rats were 10-mm transected unilaterally and repaired with Dl-lactic-ε-caprolactone conduits. Rats were then treated locally with saline, ASCs, or GHR. At 12 weeks post-surgery, we assessed limb function by measuring ankle stance angle and percentage muscle mass reduction and evaluated the histopathology, immunohistochemistry, ultrastructure, and morphometry of myelinated fibers. MAIN RESULTS: Rats receiving GHR or ASCs showed no significant increased functional recovery in ankle stance angle (p=0.372) but a higher nerve area (p=0.015), myelin area (p=0.046) and number of myelinated fibers (p=0.012) in the middle and distal segments of operated sciatic nerves in comparison to saline-treated control animals. CONCLUSION: These results suggest that utilization of ghrelin or ASCs may improve nerve regeneration using Dl-lactic-ε-caprolactone conduits.

Nuevas aportaciones y controversias en cirugía de mano / No disponible

No disponible

Comparison of Outcomes of Intertrochanteric Fracture Fixation Using Percutaneous Compression Plate Between Stable and Unstable Fractures in the Elderly.

OBJECTIVES: To evaluate the outcomes of treatment with a percutaneous compression plate (PCCP) in stable and unstable intertrochanteric hip fractures. DESIGN: Clinical prospective nonrandomized cohort study. SETTING: San Cecilio University Hospital, Granada (Spain). A tertiary-care hospital. PATIENTS: Patients older than 65 years undergoing surgery for an intertrochanteric hip fracture (n = 657) were divided according to the OTA/AO classification, into stable (31-A1) (group A, n = 363) and unstable fractures (31-A2) (group B, n = 294). INTERVENTION: Osteosynthesis with a PCCP (Orthofix Inc). MAIN OUTCOME MEASUREMENTS: Blood loss, wound complications, postoperative pain, operative and fluoroscopy time, functional outcomes, device-related complications, consolidation time, and mortality. RESULTS: Patients with unstable fractures were significantly worse with respect to postoperative pain, immediately (P = 0.020), at 6 weeks (P = 0.0001), and at 3 months (P = 0.009), and with respect to independent walking ability at 6 weeks. No other significant differences were observed. CONCLUSIONS: The outcomes of osteosynthesis with PCCP seem to be equally satisfactory in stable and unstable intertrochanteric fractures, with stable fractures having less pain and a greater ability to walk earlier. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Evaluación clínico radiográfica de una serie de 18 carpectomías de la primera hilera / Functional and radiographic outcomes following proximal row carpectomy in 18 patients

Objetivos: Analizar los resultados funcionales y grado de satisfacción de la carpectomía en una serie de 18 pacientes. Material y métodos: Estudio retrospectivo de una serie de 18 pacientes sometidos a una carpectomía (4-SNAC, 6-SLAC, 5-Kiembock, 1-pseudoartrosis de escafoides, 1-Preisser, y 1-luxación perilunar del carpo crónica), seguimiento medio de 34 meses. Se realizó una evaluación clínica mediante Mayo Wrist Score, Quick DASH, EVA, rango de movilidad, grado de satisfacción; y una valoración de los cambios radiográficos. Resultados: Tras la intervención el dolor preoperatorio mejora en 4,13 puntos, y la puntuación del Quick Dash se reduce en 39,41. El rango de movilidad medio es de 38º de flexión, 46º de extensión, 11º de desviación radial y 22º de desviación cubital. La fuerza de prensión media fue de 33.2 kg. Existen diferencias significativas entre el EVA y Quick DASH (p<0.001), además de una correlación positiva entre la edad y el dolor postoperatorio. Conclusiones: La carpectomía es un procedimiento con pocas complicaciones, que proporciona resultados de movilidad, mejoría del dolor y fuerza superiores a los criterios funcionales de Palmer. Hemos observado los mejores resultados en mujeres y pacientes de mayor edad. La aplicación de un colgajo de interposición no evita una degeneración radiográfica

Objectives: To analyze functional outcomes and satisfaction in a series of 18 carpectomies. Materials and Methods: Retrospective study of a series of 18 cases who underwent proximal row carpectomy (4-SNAC, 6-SLAC, 5 Kienböck, 1-scaphoid nonunion, 1-Preisser, and 1-perilunar chronic carpal dislocation), mean follow- up of 34 months. Clinical evaluation through Mayo Wrist Score, Quick DASH, VAS, range of motion, degree of satisfaction; and an assessment of radiographic changes. Results: Preoperative pain improved 4.13 points, and Quick Dash score was reduced 39.41 points. The range of motion average was: flexion 38º , extension 46 º, 11 º 22 º radial and ulnar deviation. The mean grip strength was 33.2 kg after surgery. There were signifi cant differences between preoperative VAS and Quick DASH and postoperative scores (p <0.001). A positive correlation between age and postoperative pain was found. Conclusions. The carpectomy is a procedure with low complication rate, which preserve funtional mobility and grip strength acording to Palmer’s criteria, and provides sustantial pain improvement. We observed the best results in women and older patients. The flap interposition doesn't prevent radiographic degeneration

Sauvé-Kapandji and reverse Sauvé-Kapandji procedures for treating chronic longitudinal radioulnar dissociation with capitellum fracture.

Almost all reported cases of longitudinal radioulnar dissociation have involved fracture of the radial head, rupture of the interosseous membrane, and disruption of the distal radioulnar joint, although unusual patterns of Essex-Lopresti injury have also been described. To our knowledge, this is the first report of a chronic Essex-Lopresti variant including fracture of the capitellum. A displaced capitellum fracture must alert to the possibility of longitudinal radioulnar dissociation, even without concomitant radial head fracture or symptoms at the forearm and ulnar wrist. Successful mid-term results can be achieved by treating malunion of humeral condyle and proximal migration of the radius with simultaneous Sauvé-Kapandji procedure at the wrist and reverse Sauvé-Kapandji at the elbow.

An ex vivo model in human femoral heads for histopathological study and resonance frequency analysis of dental implant primary stability.

OBJECTIVE: This study was designed to explore relationships of resonance frequency analysis (RFA)-assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. MATERIAL AND METHODS: This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. RESULTS: As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). CONCLUSION: Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies.

Rupture of extensor tendon secondary to previously undiagnosed Kienböck disease.

We report three patients with an unusual pattern of rupture of the extensor tendon. All were found to have previously undiagnosed Kienböck disease. Radiographic study of the wrist is essential before treating any closed rupture of an extensor tendon. Lesions may be progressive and extend to adjacent tendons and should be treated urgently.