Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. / Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos.

INTRODUCTION: Radial head fractures represent 33-75% of elbow fractures (30 cases/100,000 population/year). "Terrible triad's Hotchkiss" is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our principal goal is to compare our results on each type of prosthesis in the context of the triad. MATERIAL AND METHODS: We conducted an observational, descriptive and retrospective study. Sample size was 47 patients. Variables analyzed were affiliation, Mason's classification, surgical aspects (moment of surgery, surgical time, prosthesis type, re-surgery), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to van Riet), Popovic's loosening areas, MEPS and Cassebaum's scales. We performed an inter-group study, on patients treated with monopolar or bipolar prosthesis, in order to see results. RESULTS: Average age was 43.5±8.9 years. 72.7% were in highly demanding jobs. Mason's fracture type iv appeared in all the cases and Regan-Morrey's type I was the most frequent coronoid fracture (42.6%). There were 22 bipolar prosthesis and 25 monopolar prosthesis. Surgery time was about 112.3±59.1minutes. External fixation was used in 6.4%. MEPS final: 85.9±15 points. Rehabilitation time was about 4.7±2.5 months. Of the patients, 76.6% returned to work. Cassebaum's results were good-excellent in 74.5% of patients. There were 3 cases of prosthetic mobilization. Heterotopic ossification appeared in 29.8% of cases and 15.2% presented overstuffing. With regard to the inter-group study, we observed that there was less surgical time with monopolar prosthesis (P=.006), fewer second look surgeries (P=.05), less stiffness (P=.04), less heterotopic ossification (P=.004) and septic loosening (P=.005), without any influence on MEPS (P=.44). CONCLUSIONS: Results obtained in terrible triads with prostheses in our experience are good. Prosthetic type influences results, because surgical time for implantation of a monopolar prosthesis was less than for a bipolar one, although rehabilitation time was longer. With bipolar prostheses, external fixation was required, with a higher rate of reinterventions, stiffness, prosthetic mobilization, heterotopic ossification and prosthetic loosening. However, there were no differences between the 2prosthetic types in terms of clinical results, like MEPS or Cassebaum scores.

Use of grafts in rotator cuff re-rupture. / Utilización de injertos en la reparación de rerroturas del manguito rotador.

INTRODUCTION AND OBJECTIVES: Rotator cuff re-ruptures appear in 38-65% of cases. In order to reduce this rate, many studies have been performed using different types of biomaterial for purely mechanical aims (re-inforce the suture) and/or biological agents (growth factor transporterts). The aim of this study is to review 22 cases treated with xenografts and analyse various current alternatives. MATERIALS AND METHODS: A descriptive and retrospective study was conducted using the variables of age, sex, laterality, time of surgery, involvement in MRI, number of anchors, and final mobility results on the Constant and the University of California Los Angeles (UCLA) validated scales. RESULTS: The study included 22 patients, with a mean age of 51.7±4.6 years. A mean of 2 anchors were used and 13 patients were treated with a porcine intestinal submucosa implant, 6 with equine pericardium, and 3 with porcine dermis. Final results were: 37.6±13 points for the Constant test, and 16.9±3.9 points on the UCLA scale. The follow up was 36±10.2 months. CONCLUSIONS: In our experience, xenografts could provide good functional results and they would be a surgical alternative to tendon transfers in cases of massive tears. Further studies should be conducted with other biomaterials.

Resultados de la reparación artroscópica mediante anclaje óseo sin nudo de lesiones del fibrocartílago triangular asociadas a fractura de extremidad distal de radio / Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture

Introducción y objetivo. Las lesiones del fibrocartílago triangular (FCT) están asociadas en muchas ocasiones con inestabilidad de la articulación radiocubital distal. El tratamiento artroscópico de estas lesiones mejora el pronóstico funcional de los pacientes afectados. El objetivo del presente trabajo es evaluar los resultados funcionales y laborales de la reparación artroscópica con anclaje óseo sin nudo de lesiones del FCT asociadas a fracturas de extremidad distal del radio. Material y método. Estudio observacional, descriptivo entre noviembre de 2011 y enero de 2014 de 21 pacientes con fractura de radio distal asociada a lesiones tipo IB de Palmer (clases 2 y 3 de Atzei) del FCT tratados mediante reparación artroscópica con anclaje óseo sin nudo (PopLok® 2,8 mm, ConMed, EE. UU.). El tiempo medio de seguimiento fue de 18 meses. Analizamos los resultados funcionales (Mayo Wrist Score) y laborales. La edad media fue de 43,0 ± 8,8 años, con un 19% de mujeres. Se hallaron 5 casos con lesión escafolunar asociada. Resultados. La media obtenida en la escala funcional de Mayo Wrist Score fue de 83,4 ± 16,1 puntos. El tiempo de baja medio fue de 153,16 ± 48,5 días. La recuperación laboral sin limitaciones fue posible en el 89,5% de los casos. No se recogieron complicaciones postoperatorias. Conclusiones. La reparación artroscópica con anclaje óseo sin nudo de lesiones IB del FCT en pacientes con fractura de radio distal supone un método de tratamiento mínimamente invasivo, que mejora la tensión en la reparación y evita el posterior destensado, en nuestra experiencia, con baja tasa de complicaciones y buenos resultados funcionales y laborales (AU)

Introduction and objective. Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. Material and methods. An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1 B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8 mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0 ± 8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. Results. Functional results reached a mean of 83.4 ± 16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16 ± 48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. Conclusions. Arthroscopic knotless anchor repair of 1 B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results (AU)

Radial head arthroplasty, 11 years experience: A series of 82 patients.

OBJECTIVES: The indications for radial head arthroplasty are essentially complex fractures with ligament damage (medial, lateral or Essex-Lopresti), and/or associated with bone damage (coronoids or olecranon). The aim of this study is to review our experience with the use of a radial head prosthesis in the context of a trauma. MATERIAL AND METHOD: An observational, descriptive and retrospective study, with a follow-up of 1- 11 years, was performed on a study group of 82 patients with a mean age of 41.6 (± 9.2) years. The inclusion criteria were: patients of working age (25-64 years) with complex radial head fractures (Mason II, III, IV), with soft tissue and bone injuries that caused instability, non-reconstructable by osteosynthesis and treated using arthroplasty. The primary variables analysed were social demographics, Mason classification, or surgical aspects such as delay, surgical time, type of prosthesis (where the bipolar prosthesis was most used, 88.6%), need of fixation or further surgery. Rehabilitation time, causes of prosthesis failure, radiological findings (according to Van-Riet), areas of loosening (according to Popovic), as well as the Mayo Elbow Performance Score (MEPS) and the Cassebaum scale. Various associated injuries were observed, such as injuries in the lateral collateral ligament of the elbow in 39% of cases, coronoid fractures in 25.6%, and an olecranon fracture in 15.9% of the series. There was one case of an Essex- Lopresti injury. The tests used for the statistical analysis were Chi squared and Fisher test for categorical variables and contingency tables. The Mann Whitney U or Kruskall Wallis tests were used for the numerical variables. Evidence level: IV. RESULTS: The mean surgical time was 100 (± 56.8) minutes. The prosthesis was fixed in 53.8% of cases. The mean score on the MEPS scale was 80.4 (± 19.3) points, being good-excellent in 71.6%. The elbow was stable in 93.7% of cases. There was moderate instability, with 10° or more in varus or valgus, and in 1.3% in the rest of the series. The rehabilitation time was lower in the fixed cases (P=.03), and there was greater rigidity (P=.03) and more sequelae (limitations in mobility, residual pain), (P<0.05) in the cases where the LCL had to be repaired (given that there were other serious injuries in these cases). When the surgical delay was less than one week, better results were obtained on the Cassebaum scale (P=.02), as well as more excellent results on the MEPS scale MEPS (P=.02). The prosthesis was removed in 11 cases (13.4%), with the main cause for removal being pain in pronosupination in 5 cases, and capitellar injuries in 4 cases, one dislocation, and one infections. The most frequent complication was rigidity (30.5%). There were 3 infections (3.7%). Popovic areas 1 and 7 had greater osteolysis. CONCLUSIONS: The presence of concomitant bone and ligament injuries determined a longer surgical time and more sequelae. Early surgery would achieve better clinical results.

Arthroscopic knotless anchor repair of triangular fibrocartilage in distal radius fracture.

INTRODUCTION AND OBJECTIVE: Lesions of triangular fibrocartilage (TFC) are associated with distal radioulnar joint instability. Arthroscopic treatment of these lesions improves functional outcome of affected patients. The aim of the present work is to evaluate functional and occupational outcome of TCF repair using an arthroscopic knotless anchor device in patients with associated distal radius fracture. MATERIAL AND METHODS: An observational, descriptive study was carried out between November 2011 and January 2014 including 21 patients with distal radius fracture and Palmer 1B lesions of TCF (Atzei class 2 and 3) that were treated by arthroscopic knotless anchor (PopLok® 2,8mm, ConMed, USA). Mean follow-up was 18 months. Functional (Mayo Wrist Score) and occupational outcome results were analyzed. Mean age of the group was 43.0±8.8 years, with 19% of the patients being female. There was an associated scapholunate lesion in 5 cases. RESULTS: Functional results reached a mean of 83.4±16.1 points onMayo Wrist Score. Mean sick-leave time was 153.16±48.5 days. Complete occupational reintegration was reached in 89.5% of cases. There were no postoperative complications. CONCLUSIONS: Arthroscopic knotless anchor repair of 1B TFC tears is a minimally invasive method of treatment that improves tension of fixation, avoiding subsequent loosen, in our experience, with few complications and good functional and occupational results.

Tratamiento de la tendinitis calcificante de hombro mediante artroscopia / Arthroscopic treatment of calcific tendinitis of the shoulder

Objetivos: Revisar los pacientes con tendinitis calcificante del hombro tratados con artroscopia y analizar esta patología. Pacientes y metodología: Estudio observacional, descriptivo y retrospectivo de 27 pacientes, ocho hombres y 19 mujeres, con una edad media de 46 ± 11 años. Tipos (De Palma): I (18,5%) y II (81,5%). Analizamos la relación de la tendinitis calcificante de hombro con la edad, sexo, lateralidad, factores predisponentes, medio diagnóstico, tratamientos previos, intervención, evolución de la calcificación, test de Constant y las secuelas. Resultados: Hubo infiltraciones previas en el 88,9% de los casos y ondas de choque en el 74%. El tiempo quirúrgico fue de 110 ± 30 minutos. El tamaño aumentó en el 4%, permaneció igual en el 44% y disminuyó en el 52% de los casos. Desapareció en el 68%. El tiempo de rehabilitación fue de 4 ± 1 meses. El test de Constant previo fue 47,4 ± 13,5 puntos y después (a los 9-12 meses desde la cirugía) fue de 82,1 ± 10,7 puntos (p<0,05). Tras la intervención hubo un 74,1% de casos con dolor persistente y síndromes capsulares en el 7,4% de los pacientes. Conclusión: La administración de ondas de choque previamente a la cirugía supone una desaparición en mayor grado de las calcificaciones, menor síndrome capsular postquirúrgico, menor número de días de baja y menor grado de incapacidades (AU)

Objective: To review patients with calcific tendinitis of the shoulder treated with arthroscopy and to analyze this pathology. Patients and methods: A retrospective, descriptive, observational study of 27 patients, 8 men and 19 women, with a mean age of 46 ± 11 years. Types (De Palma): I (18.5%) and II (81.5%). We analyzed the relationship of calcific tendinitis of the shoulder with age, sex, laterality, predisposing factors, diagnostic method, previous treatments, intervention, clinical course of calcification, Constant test and sequelae. Results: Patients received previous filtrations in 88.9% of cases and shock waves in 74%. Surgical time was 110 ± 30 minutes. Size increased in 4%, remained unchanged in 44%, and decreased in 52% of cases. It disappeared in 68%. Rehabilitation time was 4 ± 1 months. Constant test was 47.4 ± 13.5 points before and 82.1 ± 10.7 points at 9-12 months after surgery (p<0.05). After surgery, 74.1% of patients had persistent pain and 7.4% had capsular syndromes. Conclusion: Administration of shock waves prior to surgery causes a greater reduction in calcifications, decreased postoperative capsular syndrome, fewer days absent from work and a lower degree of disability (AU)

Tratamiento quirúrgico de las fracturas de tercio distal del húmero a propósito de 36 casos / Surgical treatment of fractures of the distal third of the humerus: A series of 36 cases

Objetivo: Revisar el tratamiento de las fracturas de paleta humeral comparando resultados clínicos y laborales entre un grupo tratado con doble placa y otro sin ella y analizar los resultados clínicos obtenidos tras osteosíntesis en paralelo o de modo perpendicular en el grupo tratado con doble placa. Material y métodos: Estudio observacional, descriptivo y retrospectivo, nivel de evidencia IIIa, donde se analizaron 36 pacientes con una edad media de 43 (DE: 10) años. El 30.6% fueron fracturas abiertas. El tiempo de seguimiento fue de 16 (DE: 5) meses. Se obtuvo la escala MEPS (Mayo Elbow Performance Score) entre un grupo tratado con doble placa y otro sin ella y los resultados entre los casos con doble placa en paralelo, frente a aquellos en perpendicular. Resultados: La escala MEPS no presentó diferencias estadísticamente significativas entre las fracturas tratadas con doble placa y aquellas sin ella (p=0,5) pero la osteosíntesis sin dos placas supone tasas de pseudoartrosis de hasta el 12,5% con una mayor tasa de complicaciones (81,3% / 73,3%) que la osteosíntesis con doble placa. Conclusiones: No hallamos diferencias clínicas entre ambos grupos aunque las fracturas tratadas con doble placa presentan una menor tasa de pseudoartrosis (AU)

Objetive: To review the management of fractures of the distal third of the humerus, comparing the clinical and occupational results between a group treated with double plates and a group without plates, and analyzing the clinical results after osteosynthesis in parallel or perpendicular in the group subjected to double plate treatment. Material and methods: A descriptive, observational retrospective study with evidence level IIIa was carried out, analyzing 36 patients with a mean age of 43 years (SD: 10). A total of 30.6% corresponded to open fractures. The mean duration of follow-up was 16 months (SD: 5). The MEPS (Mayo Elbow Performance Score) was compared between the group treated with double plates and the group without plates, and between osteosynthesis in parallel or perpendicular in the group subjected to double plate treatment. Results: The MEPS showed no statistically significant differences between the group treated with double plates and the group without plates (p=0.5), though osteosynthesis without double plating was associated with a pseudoarthrosis rate of up to 12.5%, and involved a higher complications rate (81.3% versus 73.3%) than osteosynthesis with double plating. Conclusions: No clinical differences were found between the two groups, though the fractures treated with double plates showed a lower pseudoarthrosis rate (AU)

Utilidad del sulfato cálcico e hidroxiapatita con antibióticos en las osteomielitis de la mano, a propósito de 2 casos clínicos / Use of calcium sulfate and hydroxyapatite with antibiotics in osteomyelitis of the hand: Two clinical cases

Las osteomielitis representan entre el 1-6% de las infecciones de la mano, cuya etiología fundamental es el Staphilococcus aureus. Presentamos 2 casos tratados eficazmente mediante legrado de la lesión y relleno con sulfato cálcico e hidroxiapatita (PerOssal®) impregnado con antibióticos, valorando el tipo de lesión, aspectos analíticos, y radiológicos. Nuestro objetivo es la revisión de esta patología, así como subrayar la utilidad de este nuevo biomaterial en la cirugía de la mano (AU)

Osteomyelitis accounts for 1-6% of all infections of the hand, the main causal agent being Staphylococcus aureus. We present two cases successfully treated with lesion curettage and filling with calcium sulfate and hydroxyapatite (PerOssal®) impregnated with antibiotics, evaluating the type of lesion, laboratory test parameters and radiological data. Our aim is to offer a review of this condition, and to underscore the usefulness of this new biomaterial in surgery of the hand (AU)

Pseudoartrosis de tibia infectada por Staphylococcus aureus meticilin resistente: Tratamiento con Linezolid oral / Infected Pseudoarthrosis of the tibia by methicillinresistant Stapyhlococcus aureus: Treatment with oral Linezolid

La pseudoartrosis de tibia infectada por Staphylococcusaureus meticilin resistente (SARM) constituye una de lasinfecciones óseas de más dificil tratamiento. Presentamosun caso clínico de un paciente de 30 años en situación depseudoartrosis infectada de tibia por SARM que fue tratadopor nuestro equipo multidisciplinar, Unidad de InfeccionesÓseas y Articulares, y tras una nueva intervenciónquirúrgica y seis semanas de tratamiento antibiótico conLinezolid oral, se consigue la estabilización de la fractura,la esterilización del hueso y curación de la infección

Infected pseudoarthrosis of the tibia by methicillin-resistantStapyhlococcus aureus (MRSA) is one of the boneinfections more difficult to treat. We report one case of apatient thirty-years-old male with an infected pseudoarthrosisof tibia by MRSA who was treated by our interdisciplinaryteam, Unit of Bone and Joints Infections and aftera new surgical procedure and six weeks of antibiotic therapywih oral Linezolid we obtained stabilitation the fracture,sterilitation the bone and resolution the infection