Intramedullary Fixation of Hand Fractures and Arthrodeses.

Intramedullary fixation has long been popular for fracture fixation in the upper extremity from the shoulder through the carpus. Recently, intramedullary fixation in the hand has gained increasing interest, specifically in the metacarpals and phalanges, corresponding with the development of improved cannulated headless screw technology. Along with the advantages of increased operative speed and less surgical dissection, which can promote rapid healing, many benefits exist, supporting their use despite some drawbacks. This article reviews the background and biomechanics of intramedullary fixation with a specific focus on cannulated headless screws, describes the application and techniques of intramedullary screw fixation in the hand, and details the associated outcomes and costs for metacarpal fractures, phalangeal fractures, and interphalangeal joint arthrodesis.

Lesão na região metacarpiana do membro torácico esquerdo de bezerra Gir decorrente de contenção para pesagem / Injury in the metacarpinal region of the left thoracic limbs resulting from retention for weighing in a Gir calf

Fraturas ósseas e luxações são mais comuns em animais jovens e, na maioria das vezes, essas fraturas ocorrem devido ao manejo incorreto desses animais, podendo levar a uma queda de produção a curto ou longo prazo, gerando perdas econômicas e produtivas de animais de alto padrão genético. Nesse contexto, o objetivo deste trabalho foi relatar a ocorrência de uma fratura na região metacarpiana do membro torácico esquerdo de uma bezerra Gir de 12 dias de idade, causada por uma contenção ineficaz durante a pesagem. O animal proveniente de uma fazenda em Umirim/CE foi encaminhado ao Hospital Veterinário de Grandes Animais do Centro Universitário INTA em Sobral/CE. Ao passar pelo exame radiográfico, foi constatada a fratura na região metacarpiana do membro torácico esquerdo. O animal foi imobilizado de forma manual, seguindo-se métodos semiológicos para minimizar o estresse. Para a imobilização do membro, foi utilizada a muleta de Thomas modificada e bandagens, associadas ao controle da dor com as drogas Flunixin meglumine (1,1mg/kg) e Fenilbutazona (4,4mg/kg). Depois da imobilização, o animal seguiu internado no HOVET-GA e, após 18 dias, foi realizada uma nova radiografia para ver o progresso a partir do tratamento adotado. Constatou-se a formação de um calo ósseo, com a ossificação da fratura, não sendo necessário o encaminhamento cirúrgico do animal. Assim, o tratamento com muleta de Thomas modificada foi efetivo para a recuperação do membro fraturado, além de ser um tratamento de baixo custo e fácil aplicação, tendo o animal apresentado uma boa resposta ao tratamento terapêutico para controle da dor.

Bone fractures and dislocations are more common in young animals and mostly occur due to incorrect handling of these animals, which can lead to a short or long-term drop in production, generating economic and productive losses of animals of high genetic standard. This study aimed to report the occurrence of a fracture in the metacarpal region of the left thoracic limb of a 12-day-old Gir heifer, caused by an ineffective restraint during weighing. The animal from a farm in Umirim/CE was sent to the Veterinary Hospital of Large Animals of the University Center INTA in Sobral/CE. The radiographic examination found a fracture in the metacarpal region of the left thoracic limb. The animal was manually immobilized following semiological methods to minimize stress. For the limb immobilization, a modified Thomas crutch and bandages associated with pain control with the drugs Flunixin meglumine (1.1mg/kg) and Phenylbutazone (4.4mg/kg) were used. After immobilization, the animal remained hospitalized at HOVET-GA and after 18 days a new radiograph was performed to evaluate the progress achieved with the treatment adopted. It was found the formation of a bone callus with the ossification of the fracture, not requiring the surgical referral of the animal. Thus, the treatment with the modified Thomas crutch was effective for the recovery of the fractured limb, in addition to being a low-cost and easy-to-apply treatment. The animal showed a good response to the therapeutic treatment for pain control.

Headless Compression Screw for Metacarpal Nonunion: Description of a New Technique and Report of 4 Cases.

Nonunion is a rare complication of metacarpal fractures and is usually associated with compound, open fractures with tissue loss and infection, or after failed surgical treatment. Repair by rigid osteosynthesis with plate and screws combined with autologous bone grafting has always been the treatment of choice for most patients. Such method allows early motion, although it has been proven that the presence of hardware may cause local soft tissue irritation. Often, hardware removal and tendon releases are necessary. We describe an original technique with a fixation method for the treatment of metacarpal nonunions, considering the excellent results attained with an intramedullary, headless screw for metacarpal fracture fixation. We report a series of three cases that evolved to bone healing with excellent clinical, functional, and radiographic outcomes.

Corrective Fifth Metacarpal Neck Osteotomy and Intramedullary Screw Fixation Technique: Technique and Case Report.

Malunion of metacarpal fractures can result in severe functional and esthetic impairment to the patient, thus requiring surgical correction. Traditionally, the fixation methods most commonly used for these fractures are the Kirschner wires or the plates and screws. However, one of the options for the fixation of metacarpal fractures is intramedullary fixation with a headless screw. This minimally invasive method can also be used for corrective metacarpal osteotomies. It has the advantages of being a minimally invasive technique and allowing the early range of motion. This minimally invasive method can also be used to stabilize the corrective metacarpal osteotomies for malunion. This case report presents a minimally invasive technique for corrective dorsal metacarpal osteotomy and fixation with a headless intramedullary screw. This alternative fixation method has the advantage of low damage to soft tissues and good functional outcomes.

Tratamiento de fracturas de falanges y metacarpianos con tornillos endomedulares compresivos / Treatment of phalangeal and metacarpal fractures with intramedullary compression screws

Objetivos: Evaluar los resultados clínicos y radiográficos de pacientes con fracturas extrarticulares de falanges y metacarpianos de la mano, tratados mediante osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados.materiales y métodos: Estudio prospectivo que incluyó a pacientes >18 años con fracturas cerradas transversales u oblicuas cortas, ex-trarticulares, de falanges y metacarpianos tratadas entre noviembre de 2016 y junio de 2019. La serie estaba integrada por 47 pacientes, con 76 fracturas (28 de metacarpianos, 27 de falange proximal y 21 de falange media). Se evaluaron los resultados clínicos y funcionales con goniometría, registrando el rango de movilidad activa total. La evaluación radiográfica se realizó sobre la base de los criterios establecidos por Pun y cols. Todos los pacientes completaron el cuestionario QuickDASH en el examen final. Resultados: El tiempo promedio de seguimiento fue de 24.5 meses. El rango de movilidad activa total promedio fue de 238° para todas las fracturas, 252° para las de metacarpianos y 230° para las de falanges. Se observó la consolidación radiográfica de todas las fracturas. El tiempo promedio de retorno a la actividad habitual fue de 79 días. El resultado final del cuestionario QuickDASH fue 4,5. No hubo complicaciones ni cirugías secundarias. Conclusiones: La osteosíntesis mininvasiva con tornillos endomedulares compresivos retrógrados resultó una alternativa eficaz para el tratamiento de fracturas extrarticulares de falanges y metacarpianos. Nivel de Evidencia: II

Objective: To study the clinical and radiological outcomes of patients with extra-articular phalangeal and metacarpal fractures who were treated with minimally invasive internal fixation using retrograde intramedullary compression screws.materials and me-thods: Prospective study in patients over 18 years of age treated for simple, transverse or short oblique, extra-articular phalangeal and metacarpal fractures between November 2016 and June 2019. The series included 47 patients and 76 fractures: 28 metacar-pal bones (MC), 27 proximal phalanges (PP), 21 middle phalanges (MP). Clinical and functional outcomes were assessed with goniometry, documenting the total active range of motion (TAM). Radiological outcomes were assessed using the criteria proposed by Pun et al. All patients completed the Quick DASH questionnaire at last follow-up. Results: The average follow-up period was 24.5 months. All study fractures average TAM was 238°, metacarpal TAM was 252°, and phalangeal TAM was 230°. Radiograph evaluation showed fracture consolidation in all cases. Average time taken to return to normal daily activities was 79 days. Average final Quick DASH score was 4.5. There were no complications nor secondary surgeries. Conclusions: Minimally invasive internal fixation with retrograde intramedullary compression screw proved to be a highly effective option in the treatment of extra-articular phalangeal and metacarpal fractures. Level of Evidence: II

Delayed, Atraumatic Index Metacarpal Fracture After Trapeziectomy and Suture-Button Suspensionplasty for Thumb Carpometacarpal Osteoarthritis: A Report of Three Cases.

Trapeziectomy with suture-button suspensionplasty is a surgical treatment option for thumb carpometacarpal osteoarthritis refractory to nonsurgical management. We describe the cases of 3 patients who presented with index metacarpal fracture, in the absence of traumatic injury, over 4 months after trapeziectomy with suture-button suspensionplasty. All 3 fractures demonstrated the same pattern: short oblique/spiral, oriented proximal radial to distal ulnar with the distal end in the vicinity of the index metacarpal button, presumably after the orientation of the metacarpal drill hole. Two of the fractures were treated with surgical fixation. Fracture healing was obtained in all cases. Two of the 3 patients remained symptomatic with thumb pain, but decided against revision treatment for the carpometacarpal osteoarthritis. The third underwent restabilization of the suture button at the time of fracture fixation. Although uncommon, index metacarpal fracture after trapeziectomy with suture-button suspensionplasty can present without trauma several months after surgery.

Intra-Articular Fracture of the Base of the First Metacarpal Bone: Treatment Through a Volar Approach.

BACKGROUND: Management of Bennett fractures has been controversial. Early reports supported closed reduction and casting with or without percutaneous pinning. Later, open reduction and internal fixation was advocated. The purpose of this article is to assess the surgical treatment using a direct volar approach. METHODS: Between March 2008 and December 2014, 21 patients with intra-articular first metacarpal fractures displaced more than 1 mm were operated on using a direct volar approach. Fixation was done with micro-screws or K-wires, always placed from ulnar to radial during thumb supination. The articular step-off, secondary displacement incidence and consolidation rate time were measured. At final follow-up, we assessed the thumbs for range of motion, residual pain, and grip strength. Sensitive areas around the scar were evaluated. Mean follow-up was 8 months. RESULTS: Anatomical reduction was achieved in all cases. One secondary displacement was registered. The mean distance between the tip of the thumb and the fifth metacarpophalangeal joint was less than 10 mm; reposition was complete. Mean palmar abduction was 63°. Grip strength averaged 84.6% of the opposite side. The mean visual analog scale score was 0. No sensory disturbances around the scar were recorded. CONCLUSIONS: The complete visualization of the first metacarpal articular surface is hard to accomplish from the dorsoradial aspect of the hand. The volar approach offers an excellent fracture exposure. It is possible to place the osteosynthesis in ulna-radial fashion from the smaller fragment achieving correct reduction and stabilization. In spite of the proximity to the radial and median nerve branches, we found no complications.

[Minimal invasive osteosynthesis with cannulated screws in metacarpal fractures]. / Osteosíntesis mínimamente invasiva con tornillos centromedulares canulados para fracturas de metacarpianos.

Metacarpal fractures comprise 18 to 44% of hand fractures. Fractures from the second to the fifth metacarpals are 88% of the metacarpal fractures and fractures of the fifth metacarpals are the most common. Fractures of the neck of the fifth metacarpal are about 20% of all the hand fractures. Most of these fractures can be treated conservatively with good functional results. However, for those neck and shaft unstable fractures that need surgical treatment, there is no gold standard for osteosynthesis. Recently, there have been reports of minimally invasive osteosynthesis using headless retrograde intramedullary cannulated screws with good functional results. MATERIAL AND METHODS: We report our short term experience treating nine fifth metacarpal neck fractures, one fourth metacarpal neck fracture and a transverse fifth metacarpal shaft fracture that did not fulfill criteria for conservative treatment. We treated them with minimally invasive osteosynthesis using retrograde intramedullary headless cannulated screws. RESULTS: All patients showed radiographic healing and had full range of motion of the metacarpophalangeal joint at one month follow up except for one patient who suffered a dorsal mutilating hand injury along with a fifth metacarpal neck fracture. One patient had osteoporotic bone and we could not control height loss with screws, so we had to use k-wires. CONCLUSION: Minimally invasive osteosynthesis with cannulated headless retrograde screws is a good option to treat neck and transverse diaphyseal fractures of the metacarpals. It confers a stable construct that allows early range of motion and return to activities.

ANTECEDENTES: Las fracturas de los metacarpianos comprenden de 18 a 44% de las fracturas de la mano. La mayoría de las fracturas simples de cuello y transversales diafisiarias de metacarpianos pueden ser tratadas de manera conservadora con buenos resultados. Sin embargo, en el caso de fracturas inestables no existe un estándar de oro para la osteosíntesis y ningún método ha mostrado hasta la fecha superioridad sobre los demás. Recientemente ha habido publicaciones sobre osteosíntesis con tornillos canulados centromedulares sin cabeza retrógrados con buenos resultados funcionales en fracturas de cuello y transversales diafisiarias de metacarpianos. MATERIAL Y MÉTODOS: Series de casos con seguimiento a corto plazo tratados con osteosíntesis retrógrada con tornillos canulados sin cabeza en nueve fracturas de cuello de quinto metacarpiano, una de cuello de cuarto metacarpiano y una transversal diafisiaria de quinto metacarpiano. RESULTADOS: Todos los pacientes lograron consolidación radiográfica y al mes de seguimiento tenían arcos de movimiento completos y realizaban actividades habituales. Una paciente con mano traumática y fractura de quinto metacarpiano presentó limitación de arcos de movimiento. En un caso con hueso osteoporótico y conminución de cortical volar no logramos evitar la pérdida de altura con tornillos, por lo que utilizamos clavillos Kirschner. CONCLUSIÓN: La osteosíntesis mínimamente invasiva con tornillos canulados retrógrados sin cabeza es una buena opción para el tratamiento de fracturas transversales de diáfisis y de cuello de metacarpianos inestables porque es mínimamente invasiva y permite movilización y regreso temprano a actividades habituales.

Osteosíntesis mínimamente invasiva con tornillos centromedulares canulados para fracturas de metacarpianos / Minimal invasive osteosynthesis with cannulated screws in metacarpal fractures

Resumen: Antecedentes: Las fracturas de los metacarpianos comprenden de 18 a 44% de las fracturas de la mano. La mayoría de las fracturas simples de cuello y transversales diafisiarias de metacarpianos pueden ser tratadas de manera conservadora con buenos resultados. Sin embargo, en el caso de fracturas inestables no existe un estándar de oro para la osteosíntesis y ningún método ha mostrado hasta la fecha superioridad sobre los demás. Recientemente ha habido publicaciones sobre osteosíntesis con tornillos canulados centromedulares sin cabeza retrógrados con buenos resultados funcionales en fracturas de cuello y transversales diafisiarias de metacarpianos. Material y métodos: Series de casos con seguimiento a corto plazo tratados con osteosíntesis retrógrada con tornillos canulados sin cabeza en nueve fracturas de cuello de quinto metacarpiano, una de cuello de cuarto metacarpiano y una transversal diafisiaria de quinto metacarpiano. Resultados: Todos los pacientes lograron consolidación radiográfica y al mes de seguimiento tenían arcos de movimiento completos y realizaban actividades habituales. Una paciente con mano traumática y fractura de quinto metacarpiano presentó limitación de arcos de movimiento. En un caso con hueso osteoporótico y conminución de cortical volar no logramos evitar la pérdida de altura con tornillos, por lo que utilizamos clavillos Kirschner. Conclusión: La osteosíntesis mínimamente invasiva con tornillos canulados retrógrados sin cabeza es una buena opción para el tratamiento de fracturas transversales de diáfisis y de cuello de metacarpianos inestables porque es mínimamente invasiva y permite movilización y regreso temprano a actividades habituales.

Abstract: Metacarpal fractures comprise 18 to 44% of hand fractures. Fractures from the second to the fifth metacarpals are 88% of the metacarpal fractures and fractures of the fifth metacarpals are the most common. Fractures of the neck of the fifth metacarpal are about 20% of all the hand fractures. Most of these fractures can be treated conservatively with good functional results. However, for those neck and shaft unstable fractures that need surgical treatment, there is no gold standard for osteosynthesis. Recently, there have been reports of minimally invasive osteosynthesis using headless retrograde intramedullary cannulated screws with good functional results. Material and methods: We report our short term experience treating nine fifth metacarpal neck fractures, one fourth metacarpal neck fracture and a transverse fifth metacarpal shaft fracture that did not fulfill criteria for conservative treatment. We treated them with minimally invasive osteosynthesis using retrograde intramedullary headless cannulated screws. Results: All patients showed radiographic healing and had full range of motion of the metacarpophalangeal joint at one month follow up except for one patient who suffered a dorsal mutilating hand injury along with a fifth metacarpal neck fracture. One patient had osteoporotic bone and we could not control height loss with screws, so we had to use k-wires. Conclusion: Minimally invasive osteosynthesis with cannulated headless retrograde screws is a good option to treat neck and transverse diaphyseal fractures of the metacarpals. It confers a stable construct that allows early range of motion and return to activities.

Acute Dislocation of the Metacarpal-Trapezoid Joint.

The trapezoid metacarpal dislocation is a rare event. In the literature, it is found in case reports. This injury is caused by direct or indirect high energy trauma. In most cases, the dislocation is dorsal and is difficult to reproduce because the joint is not very mobile. Given the low incidence and little evidence supported in the literature regarding the management, this injury can be treated by open or closed reduction; however, it has been published that most authors use Kirschner wire fixation with good results. Here we present our experience in the management of a male patient with acute trapezoid metacarpal dislocation handled with a splint with good functional results at 6 weeks.

The Effect of Closed Reduction of Small Finger Metacarpal Neck Fractures on the Ultimate Angular Deformity.

PURPOSE: To assess whether or not attempted closed reduction of fifth metacarpal neck fractures results in decreased fracture angulation at final follow-up. METHODS: Retrospective chart review of all patients aged 18 and older managed for isolated fifth metacarpal neck fractures between 2004 and 2014. RESULTS: Sixty-six patients managed for an isolated boxer fracture met inclusion criteria. Twenty-three patients underwent attempted reduction and 43 patients did not. Patients undergoing attempted reduction had a statistically significant improvement in fracture angulation following reduction compared with patients not undergoing attempted reduction. At final follow-up, there was no difference in fracture angle between the 2 groups. CONCLUSIONS: Closed reduction and splint immobilization of fifth metacarpal neck fractures was not an effective means of maintaining a significant improvement in fracture alignment upon healing. Other means, such as closed reduction with pin fixation or open reduction internal fixation, should be considered when maintenance of reduction is desired. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.

Fractures of the accessories metacarpals bones and incidence of desmitis of the suspensory ligament in polos horses: retrospective study of 35 cases / Fraturas dos metacárpicos acessórios e a incidência da desmite do suspensório de boleto em cavalos de pólo: estudo retrospectivo de 35 casos

The fractures of the accessories metacarpals bones are common in race horses, trotting, jumping and polo. The desmitis of the suspensory ligament (LSB) may be associated with fracture or periosteal proliferation in the axial accessory metacarpal, which compresses the LSB and cause injury. The aim of this study was the retrospective study of cases of fracture of accessory metacarpal in polo´s horses, who underwent partial ostectomy, correlating with the incidence of desmitis LSB. Were studied 35 cases, and 29 (82.86%) of the fractures were in the right forelimb (M.T.D) and six (17.14%) in the left forelimb (M.T.E). Twenty-five of 35 fractures (71.42%) involved the fourth metacarpal bone, 21 (72.41%) in the right forelimb and four (66.66%) in the left forelimb and 10 (28.57%) involved the second bone MTC-II, 8 (80%) in the right forelimb and 2 (20%) in the left forelimb. Fifteen animals had desmitis the LSB, representing 42.85% of the total, but only 26.7% had acute lesions, demonstrating that the desmitis the LSB is not directly related to fractures of accessories metacarpals bones, which are caused by direct trauma during sport. It was concluded that the incidence of bone fractures metacarpal accessories, polos horses are more common in right forelimbs and fourth metacarpals bones.

As fraturas dos ossos metacárpicos acessórios (MTCa) são comuns em cavalos de corrida, trote, salto e pólo. A desmite do suspensório do boleto (LSB) pode estar associada à fratura ou proliferação periostal no eixo axial do MTCa, que comprime o LSB e causa a lesão. O objetivo deste trabalho foi realizar o estudo retrospectivo dos casos de fraturas de MTCa em cavalos de pólo, submetidos à ostectomia parcial, correlacionando o membro acometido e a incidência de desmite de LSB. Foram estudados 35 casos, sendo que 29 (82,86%) das fraturas foram no membro torácico direito (M.T.D.) e seis (17,14%) no membro torácico esquerdo (M.T.E.). Das 35 fraturas, 25 (71,43%) ocorreram no quarto metacárpico (MTC-IV), sendo 21 (84%) no M.T.D. e quatro (16%) no M.T.E e 10 (28,57%) ocorreram no MTC-II, sendo 8 (80%) no M.T.D e 2 (20%) no M.T.E. Quinze animais apresentavam desmite do LSB, representando 42,85 % do total, porém apenas 26,7% apresentavam lesões agudas, demonstrando assim que, a desmite do LSB não está relacionada diretamente às fraturas de MTCa, sendo estas ocasionadas por traumas diretos durante o esporte. Concluiu-se que a incidência das fraturas nos ossos metacárpicos acessórios, em cavalos de pólo são mais comuns nos membros torácicos direito e quartos ossos metacárpicos.

Fractures of the accessories metacarpals bones and incidence of desmitis of the suspensory ligament in polos horses: retrospective study of 35 cases / Fraturas dos metacárpicos acessórios e a incidência da desmite do suspensório de boleto em cavalos de pólo: estudo retrospectivo de 35 casos

The fractures of the accessories metacarpals bones are common in race horses, trotting, jumping and polo. The desmitis of the suspensory ligament (LSB) may be associated with fracture or periosteal proliferation in the axial accessory metacarpal, which compresses the LSB and cause injury. The aim of this study was the retrospective study of cases of fracture of accessory metacarpal in polo´s horses, who underwent partial ostectomy, correlating with the incidence of desmitis LSB. Were studied 35 cases, and 29 (82.86%) of the fractures were in the right forelimb (M.T.D) and six (17.14%) in the left forelimb (M.T.E). Twenty-five of 35 fractures (71.42%) involved the fourth metacarpal bone, 21 (72.41%) in the right forelimb and four (66.66%) in the left forelimb and 10 (28.57%) involved the second bone MTC-II, 8 (80%) in the right forelimb and 2 (20%) in the left forelimb. Fifteen animals had desmitis the LSB, representing 42.85% of the total, but only 26.7% had acute lesions, demonstrating that the desmitis the LSB is not directly related to fractures of accessories metacarpals bones, which are caused by direct trauma during sport. It was concluded that the incidence of bone fractures metacarpal accessories, polos horses are more common in right forelimbs and fourth metacarpals bones.(AU)

As fraturas dos ossos metacárpicos acessórios (MTCa) são comuns em cavalos de corrida, trote, salto e pólo. A desmite do suspensório do boleto (LSB) pode estar associada à fratura ou proliferação periostal no eixo axial do MTCa, que comprime o LSB e causa a lesão. O objetivo deste trabalho foi realizar o estudo retrospectivo dos casos de fraturas de MTCa em cavalos de pólo, submetidos à ostectomia parcial, correlacionando o membro acometido e a incidência de desmite de LSB. Foram estudados 35 casos, sendo que 29 (82,86%) das fraturas foram no membro torácico direito (M.T.D.) e seis (17,14%) no membro torácico esquerdo (M.T.E.). Das 35 fraturas, 25 (71,43%) ocorreram no quarto metacárpico (MTC-IV), sendo 21 (84%) no M.T.D. e quatro (16%) no M.T.E e 10 (28,57%) ocorreram no MTC-II, sendo 8 (80%) no M.T.D e 2 (20%) no M.T.E. Quinze animais apresentavam desmite do LSB, representando 42,85 % do total, porém apenas 26,7% apresentavam lesões agudas, demonstrando assim que, a desmite do LSB não está relacionada diretamente às fraturas de MTCa, sendo estas ocasionadas por traumas diretos durante o esporte. Concluiu-se que a incidência das fraturas nos ossos metacárpicos acessórios, em cavalos de pólo são mais comuns nos membros torácicos direito e quartos ossos metacárpicos.(AU)

Utilização de métodos não invasivos de imagem para avaliação da regeneração óssea em falhas ósseas induzidas experimentalmente em III/IV metacarpianos de ovinos / Use of non-invasive imaging methods for evaluation of bone regeneration in bone defects induced experimentally in III/IV metacarpus of sheep

Background: The events involved in the process of bone regeneration of fractures are influenced by physiological factors and a number of techniques can be used to assess bone tissue. The radiographic examination (ER) is often used in clinical practice to evaluate the consolidation process. Ultrasound (US) allows evaluation of the fibrous callus, present in early stages of consolidation. Thermograph is method of evaluation for image, which allows you to estimate activity of some tissue. The aim of this study was to evaluate bone fill process, during 60 days, through thermograph, ultrasound and x-ray of ostectomy induced experimentally.Materials, Methods & Results: Six female Santa Inês breed ewes were subjected to unicortical ostectomy of seven millimeters in diameter, in the proximal region of the dorsum-medial surface of III/IV metacarpal, chosen randomly. The animals were submitted to radiographic evaluations, ultrasound and thermograph, prior to the surgery and during 60 days, in between 7, 14, 21, 28, 35, 42, 49 and 56 days postoperatively. The radiographic images were evaluated by examiners “blind” (two radiologists and two sonographers), that didn’t know the postoperative day that the image member evaluated. The thermograph images were processed in program for measuring the average temperature in the region of bone gap, over time. The Friedman test was applied to assess the progression of the studied variables over the period of the experiment. Over the period of 60 days it was possible to observe the difference of fault, fill scores by radiographic examination and ultrasound examination (P < 0.001). The Wilcoxon test was applied to observer the differences in scores between the examiners over the period of the experiment. Statistically significant difference was observed between the evaluators of radiographic images from day 14, not being observed between by the evaluators of ultrasound images.[...]

Utilização de métodos não invasivos de imagem para avaliação da regeneração óssea em falhas ósseas induzidas experimentalmente em III/IV metacarpianos de ovinos / Use of non-invasive imaging methods for evaluation of bone regeneration in bone defects induced experimentally in III/IV metacarpus of sheep

Background: The events involved in the process of bone regeneration of fractures are influenced by physiological factors and a number of techniques can be used to assess bone tissue. The radiographic examination (ER) is often used in clinical practice to evaluate the consolidation process. Ultrasound (US) allows evaluation of the fibrous callus, present in early stages of consolidation. Thermograph is method of evaluation for image, which allows you to estimate activity of some tissue. The aim of this study was to evaluate bone fill process, during 60 days, through thermograph, ultrasound and x-ray of ostectomy induced experimentally.Materials, Methods & Results: Six female Santa Inês breed ewes were subjected to unicortical ostectomy of seven millimeters in diameter, in the proximal region of the dorsum-medial surface of III/IV metacarpal, chosen randomly. The animals were submitted to radiographic evaluations, ultrasound and thermograph, prior to the surgery and during 60 days, in between 7, 14, 21, 28, 35, 42, 49 and 56 days postoperatively. The radiographic images were evaluated by examiners “blind” (two radiologists and two sonographers), that didnt know the postoperative day that the image member evaluated. The thermograph images were processed in program for measuring the average temperature in the region of bone gap, over time. The Friedman test was applied to assess the progression of the studied variables over the period of the experiment. Over the period of 60 days it was possible to observe the difference of fault, fill scores by radiographic examination and ultrasound examination (P < 0.001). The Wilcoxon test was applied to observer the differences in scores between the examiners over the period of the experiment. Statistically significant difference was observed between the evaluators of radiographic images from day 14, not being observed between by the evaluators of ultrasound images.[...](AU)

Tratamiento de fracturas de metacarpianos con método de banda de tensión / Treatment of metacarpal fractures with tension band method

En estudio clínico prospectivo donde se evaluaron 48 pacientes que acudieron al Servicio de Traumatología y Ortopedía del Hospital General del Oeste "Dr. José Gregorio Hernández", Caracas, Venezuela con 54 fracturas transversas u oblicuas cortas de metacarpianos, entre junio de 1998 hasta septiembre de 2001, tratados con alambre de cerclaje usando el método de banda de tensión. El promedio de edad fue de 28,9 años, siendo las peleas el motivo más común con 79,17 por ciento. El metacarpiano mas afectado fue el 5to metacarpiano para un 72,22 por ciento y el 42,31 por ciento representó el cuello del mismo. La amplitud de movimiento articular fue excelente en 95,83 por ciento y buenos en 4,17 por ciento.

Músculo accesorio del abductor largo del pulgar o tercer abductor / Accessory long abductor muscle of the thumb or third abductor

En el estudio de los tendones del músculo accesorio del abductor largo del pulgar, basados en la disección anatómica de 250 cadáveres adultos de raza mestiza del altiplano y valle, registramos que las variaciones anatómicas son muy frecuentes. La presencia de tendones accesorios ocurrió en todas las piezas disecadas. Este músculo constante, en nuestro medio se origina en el tercio inferior de la cara dorsal del radio, ulna y de la membrana interósea; diferenciandose del abductor largo del pulgar y del extensor corto del pulgar. Se dirige hacia abajo al nivel de la muñeca, pasa por debajo del retináculo extensor en la primera corredera osteofibrosa de la epífisis distal del radio junto con el abductor largo y extensor corto del dedo pulgar. Su inserción distal se realiza en primer metacarpiano.

In the study of the tendons of the accessory muscle of the long abductor of the thumb, based on the anatomical dissection of 250 mature cadavers of mestizo race of the highland and valley, we register that the anatomical variations are very frequent. The presence of accessory tendons happened in all the dissected pieces.This constant muscle, in our means, originates in the inferior third of the dorsal face of the radius, ulna and of the membrane interosseous; differing of the long abductor of the thumb and of the extending one short of the thumb. He she goes down, at the doll's level, it passes below the extending retináculo in the first sliding osteofibrosa of the lower extremity of the radius together with the short long and extending abductor of the thumb. Their insert distal is carried out in first metacarpal.

Reconstrucción de metacarpiano en heridas por armas de fuego / Reconstruction of metacarpal wounds by firearms

Estudio prospectivo tipo serie de casos que describe la experiencia del Hospital Militar Central entre Diciembre de 1995 y Diciembre del 2002, en 35 pacientes, con fracturas de metacarpianos ocasionados por armas de fuego de alta velocidad, con defectos segmentarios tratados con injerto óseo tricortical y osteosíntesis estable. 100 % sexo masculino y promedio de seguimiento de 17 meses (9 - 24). Como consideraciones para este tratamiento se tiene la viabilidad funcional del dedo, presencia de infección, compromiso de tejidos blandos y condiciones generales del paciente. Manejo inicial fijación transitoria con clavos, lavados quirúrgicos y férula de protección. Los resultados mostraron integración ósea en 12.5 semanas (8 a 32), pérdida función MF del 20 % y baja tasa de complicaciones. Se recomienda este tipo de procedimiento como una buena alternativa de tratamiento en este tipo de lesiones.