Resección de la primera fila del carpo en pacientes mayores de 50 años: 3 a 16 años de seguimiento / Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up

Objetivo: Conocer los resultados a largo plazo y el pronóstico de los pacientes que han sido intervenidos de resección de la primera fila del carpo (RPFC) en nuestro centro. Material y método: Realizamos un estudio retrospectivo de 14 pacientes intervenidos de RPFC con un seguimiento de 3 a 16 años. Se evaluaron la movilidad, la capacidad funcional mediante el cuestionario Patient-Rated Wrist Evaluation (PRWE) y la capacidad para realizar las actividades de la vida diaria tras la intervención. Resultados: El balance articular fue satisfactorio. La puntuación media en la escala PRWE fue de 20,9+/-17,2 para la subescala de dolor y de 39+/-35,5 para la subescala de funcionalidad. Ningún paciente había precisado reintervención ni han desarrollado complicaciones. El 80% de los pacientes estuvieron satisfechos o muy satisfechos. El 90% de los pacientes volvería a operarse. Discusión: El rango de movimiento de la muñeca es similar con las diferentes técnicas de preservación de la movilidad. Los cambios artrósicos en la articulación radio-hueso grande secundarios a esta intervención no producen necesariamente dolor. Algunos autores han descrito que el grado de satisfacción de la RPFC es comparable con el de otros procedimientos, como la artrodesis en 4 esquinas con placa circular o artrodesis mediocarpiana con agujas. Conclusión: La RPFC tiene alta tasa de satisfacción entre los pacientes con alivio del dolor, buena movilidad y funcionalidad postoperatoria de la muñeca. Además, presenta escasas complicaciones

Objective: To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. Material and method: This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). Results: The range of movement was satisfactory. The mean score on the PRWE scale was 20.9+/-17.2 for the pain subscale and 39+/-35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. Discussion: The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. Conclusion: PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications

Proximal row carpectomy in patients older than 50 years: 3 to 16 years of follow-up. / Resección de la primera fila del carpo en pacientes mayores de 50 años: 3 a 16 años de seguimiento.

OBJECTIVE: To analyze the long-term results and the prognosis of patients who have undergone proximal row carpectomy (PRC) in our hospital. MATERIAL AND METHOD: This is a retrospective study of 14 patients undergoing PRC with a follow-up of 3 to 16 years. The ability to perform daily activities, mobility and functional capacity after the surgery were assessed using the Patient-Rated Wrist Evaluation questionnaire (PRWE). RESULTS: The range of movement was satisfactory. The mean score on the PRWE scale was 20.9±17.2 for the pain subscale and 39±35.5 for the functional capacity subscale. None of the patients required revision surgery or developed complications. Eighty percent of the patients were satisfied or very satisfied. Ninety percent of the patients would undergo surgery again. DISCUSSION: The wrist's range of movement achieved with this technique is similar to that obtained with other mobility preservation techniques. Secondary arthritic changes in the radio-capitate joint do not necessarily produce pain. Some authors have described that the degree of satisfaction after PRC is equivalent to that of other procedures such as arthrodesis in 4 corners with circular plate arthrodesis or middle-carpal arthrodesis. CONCLUSION: PRC achieved high satisfaction rates among the patients providing pain relief, good mobility and post-operative functionality of the wrist. In addition, it presented few complications.

Osteoid osteoma mimicking triangular fibrocartilage complex injury: diagnosis and review of treatment.

We report the case of osteoid osteoma (OO) with ulnar styloid involvement. A review of the literature has been made with the aim of defining the special behaviour of OO when it is near the articular surface. That behaviour can affect the diagnosis, masking the real etiology of the pain, delaying the diagnosis, missing the diagnosis, or what is more serious, conducting an inadequate treatment. We propose a treatment algorithm conducted based on the localization near or far from articular surface and the superficial or deep localization.

Cuándo aflojar el manguito neumático de isquemia: su influencia sobre las pérdidas hemáticas y posibles complicaciones en la prótesis total de rodilla. Estudio prospectivo multicéntrico / The timing of tourniquet release: its influence on blood loss and possible complications after total knee arthroplasty. A prospective multicenter study

Objetivo. Realizar un estudio prospectivo multicéntrico de selección alternante para valorar las pérdidas hemáticas postoperatorias de la prótesis total de rodilla en relación con el momento de soltar la isquemia, realizando o no hemostasia, y las posibles complicaciones locales y generales.Material y método. Se analizan 194 pacientes (194 rodillas) distribuidos en dos grupos homogéneos:1. Grupo I hemostasia (H): se libera el torniquete de isquemia después de la colocación de los implantes metálicos, realizando la hemostasia previa al cierre de la herida quirúrgica.2. Grupo II no hemostasia (NH): se coloca la prótesis, se realiza el cierre de la herida quirúrgica, se coloca vendaje compresivo y en este momento se afloja el manguito neumático.Resultados. El sangrado promedio total del grupo I (H) fue de 721cc. (30-2210) y el del grupo II (NH) fue de 625cc. (60-1540), no existiendo diferencias significativas entre ambos grupos (p = 0,3). No se encuentran tampoco diferencias significativas entre ambos grupos con respecto a las complicacioneslocales o generales.Conclusión. Las pérdidas hemáticas postoperatorias no serelacionan directamente con el momento de soltar la isquemia durante las prótesis totales de rodilla

Purpose. We conducted a prospective multicenter study with alternate selection methodology in order to evaluate postoperative blood loss further to primary knee replacement at the time of tourniquet release, with or without hemostasis, as well as possible local and systemic complications.Materials and methods. We studied 194 patients (194 knees) divided into two similar groups. Group I (Hemostasis - H) - the tourniquet was deflated intraoperatively after implantation of the metal components and hemostasis was achieved prior to wound closure. Group II (No Hemostasis - NH) - the tourniquet was released after the wound was closed and a compressive bandage applied.Results. Mean bleeding was 721ml (30-1540) for group I and 625 ml (60-1540) for group II. No statistically significant differences were found (p = 0.3). No significant differences were found between the groups as regards general or local complications.Conclusions. Postoperative blood loss is not related directly with the time of tourniquet release further to TKR. Our findings cast certain doubts on the efficacy of tourniquet release, which means that intraoperative hemostasis may not be necessary (AU)

Incorporación de aloinjertos óseos intercalares corticales. Estudio experimental en conejos / Incorporation of cortical intercalary bone allografts. Experimental study on rabbits

Se realiza un estudio experimental en 40 conejos para valorar la incorporación de grandes aloinjertos óseos intercalares y la influencia de la congelación en el injerto óseo. En 36 conejos adultos se procedió a resecar 3 centímetros diafisarios de tibia y el defecto se reconstruyó con diferente tipo de injerto óseo: autoinjerto fresco y autoinjerto congelado, aloinjerto fresco y aloinjerto congelado; la osteosíntesis se realizó con dos agujas de Kirschner intramedulares. Se hicieron estudios radiológicos mensuales hasta el sacrificio, a los 2, 4 y 8 meses. Se hizo un estudio densitométrico, histológico y de diafanización con técnica de Spalteholz de las tibias. En 24 animales se administraron 25 mg/kg de oxytetraciclina al 3º y 6º días antes del sacrificio para estudiar la velocidad de aposición ósea en el injerto. Observamos una consolidación radiológica buena y excelente en el 80 por ciento de los injertos (99 por ciento en los autoinjertos y 66 por ciento en los aloinjertos). La densidad ósea mostraba un descenso hasta el 4º mes debido a la reabsorción ósea excepto en el grupo de los aloinjertos frescos. La revascularización de los aloinjertos fue más lenta y pobre que en los autoinjertos, pero con el mismo patrón vascular. La incorporación y neoformación ósea fueron mayores en los autoinjertos sin diferencias significativas con los aloinjertos congelados. La velocidad de aposición ósea no se modificó con los diferentes tipos de injertos óseos utilizados. La congelación facilita y acelera la incorporación y cantidad de neoformación ósea de los aloinjertos (AU)

[Incorporation of cortical intercalary bone allografts. Experimental study on rabbits]. / Incorporación de aloinjertos óseos intercalares corticales. Estudio experimental en conejos.

An experimental study was carried out on 40 rabbits in order to evaluate the incorporation of large intercalary bone allografts and the influence of freezing on the bone graft. In 36 rabbits resection of 3 centimetres of diaphysis of the tibia was carried out and the defect was rebuilt with different types of bone graft: fresh autograft and frozen autograft, fresh allograft and frozen allograft; osteosynthesis was carried out with two intramedullary Kirschner needles. Monthly radiological studies were made until the sacrifice of the animals, at 2, 4 and 8 months. A densitometric, histological and diaphanisation study of the tibias was made with Spalteholz's technique. In 24 animals 25 mg/kg of oxytetracicline was administered 3 and 6 days before sacrifice, to study the velocity of bone apposition in the graft. We observed a good and excellent radiological consolidation in 80% of the grafts (99% in the autografts and 66% in the allografts). The bone density showed a fall until the 4th month due to bone reabsorption except in the group of fresh allografts. The revascularization of the allografts was slower and poorer than the autografts, but with the same vascular pattern. Bone incorporation and neoformation were greater in the autografts without significant differences with the frozen allografts. The speed of bone apposition did not change with the different types of bone graft used. Freezing facilitated and accelerated incorporation and the quantity of bone neoformation of the allografts.

[Long-term results of total trapezium-metacarpal joint arthroplasty using the de la Caffinière cemented prosthesis]. / Resultados a largo plazo de la artroplastia total de la articulación trapeciometacarpiana mediante la prótesis cementada "de la Caffinière".

BACKGROUND: We report a series of 13 arthroplasties using De la Caffinière cemented trapezium-metacarpal prostheses which were implanted to treat unstable and painful TM arthrosis in our department. 10 patients were women and 1 was a man. Mean age, 65 years (range 50 to 75 years). 2 patients received bilateral implants. The mean follow-up was 8 years. The mean mobility of the operated side compared with the opposite thumb were: abduction 38 degrees/39 degrees, flexion 7 degrees/9 degrees y extension 29 degrees/31 degrees. The radiography showed in one case a radiolucent area around the trapezium component of the prosthesis with no clinical repercussion. The subjective results were good in 9 cases and acceptable in 2. The good long-term results of this procedure make it a valid alternative for the treatment of painful TMC arthrosis which limits normal function.

Reconstrucción del extremo distal de radio mediante aloinjerto osteoarticular contralateral después de la resección de un tumor esquelético / No disponible

La reconstrucción radio distal tras la resección de tumores en esa localización, constituye un desafío para el cirujano ortopédico. Hemos modificado la técnica de reconstrucción utilizando el aloinjerto osteoarticular de radio distal contralateral y presentamos nuestra experiencia. El objetivo principal de esta modificación es evitar la inestabilidad estructural del aloinjerto de radio y mejorar su función. Estabilizamos el aloinjerto contralateral mediante una placa y tornillos sobre la superficie volar del radio. El complejo fibrocartilago triangular y los ligamentos palmares de la muñeca se suturan a los ligamentos correspondientes del aloinjerto. La articulación de la muñeca se fija con agujas de Kirschner durante 6 semanas. Se evaluaron cuatro pacientes con aloinjerto osteoarticular de radio distal contralateral con una edad media de 28 años (rango de 23 a 33) y con una media de seguimiento de 42 meses. Obtuvimos ausencia de recidivas locales y una correcta consolidación del aloinjerto en todos los casos. El rango de movilidad articular medio fue 36,3° flexión dorsal, 17,5° flexión volar, 10,7° abducción, 10° aducción, 62,5° pronación y 46,3° de supinación. La reconstrucción del radio distal con aloinjerto contralateral es una técnica útil para solucionar grandes defectos osteoarticulares y provee mayor estabilidad articular al cambiar la orientación de la carilla articular del radio (AU)

The reconstruction of the distal radius after excision of a skeletal tumor in this location is a challenge for the orthopedic surgeon. The objective of our modification is to prevent structural instability in the allograft and improve its function. We report our experience with the use of a contralateral osteoarticular allograft. The allograft was stabilized with a plate and screws above the volar surface of the radius. The palmar ligaments of the wrist and the fibrocartilage complex were sutured to the corresponding ligaments of the allograft. The wrist joint was fixed with a Kirschner wire for six weeks. We report 4 patients with a contralateral osteoarticular allograft. The average age was 28 years (range 23 to 33) and the average follow-up was 42 months. The average range of wrist motion was: dorsal flexion 36.3°; volar flexion 17.5°; abduction 10.7°; adduction 10°; supination 46.3° and pronation 62.5°. Correct union of the allografts and absence of local recurrence of the tumor was obtained in all patients. The reconstruction of the distal radius with a contralateral osteoarticular allograft is a useful technique for repairing large defects and greater joint stability is achieved by changing direction of the articular surface of the radius (AU)

Surgical management of neural injuries associated with elbow fractures in children.

Twenty-two patients with 25 neural injuries at the elbow joint were reviewed. Follow-up lasted 2 years after surgery. Mean age was 9.4 years. Findings at surgery revealed discontinuity of the affected nerve trunk in eight cases; 17 cases showed a constrictive lesion with the nerve trunk in continuity. Surgical technique involved repair by interfascicular grafting in six lesions, two by epineural suture, and 17 by neurolysis. The mean interval between injury and surgery was 10.1 months (range, 1-40). Motor and sensory function assessment was according to the Nerve Injuries Committee of the British Medical Research Council (preoperatively and at the final follow-up). Excellent results were found in nearly 80% of the continuous lesions treated by neurolysis. In discontinuous lesions, we found 66% with excellent results with grafting. The prognosis after neurolysis in continuous lesions is excellent. In discontinuous lesions after surgery, the rate of recovery is high. There is a poor prognosis for surgery performed > or = 1 year after the injury.

Extradigital glomus tumour causing thigh pain: a case report.

Glomus tumours are rare and benign, arising from a neuromyoarterial glomus body, most commonly in the hand. We report a patient with such a tumour in an atypical site, the right vastus lateralis. Pain was aggravated by muscle contraction, and ultrasonography and MRI were required to locate the lesion accurately. Surgical excision gave immediate pain relief.

[Current indications for reimplantation of the upper extremity]. / Indicaciones actuales de los reimplantes de la extremidad superior.

In the last decades there has been a great development in microsurgery that has enabled successful replantation of totally severed parts. Nowadays, the important issue is to decide which segments should be replanted, in order to achieve a good functional result. In this paper we study the indications and contraindications of replantation, based in our experience and we present a review of the recent literature. We consider the following aspects: general condition and age of the patient, mechanism of lesion, amputation level, ischemic time and also economic aspects. We conclude that replantation should be attempted in thumb and multiple digits amputations, in amputations at the palm, wrist and forearm, in single digit amputations distal to the flexor superficialis insertion and in any case in children.

Nerve regeneration in different types of grafts: experimental study in rabbits.

The nerve regeneration patterns of five different types of grafts were studied in 40 rabbits. Conventional nerve autografts, vascularized nerve autografts, fresh nerve allografts, frozen nerve allografts, and muscle autografts were sutured to a 1.5 cm gap in the sciatic nerve and compared with normal nerves and nerves with a 3 cm gap. Regeneration was evaluated by means of electromyography, light and electron microscopy. Quantitative data from morphometric analysis of axonal diameter and myelination were statistically analyzed. Results 5 months after grafting showed no significant differences between the conventional and vascularized nerve autografts. There were no significant differences between frozen nerve allografts and muscle autografts. The best regeneration was achieved with autografts.

[Extra-abdominal desmoid tumors. Diagnostic-therapeutic considerations and review of the literature]. / Tumores desmoides extraabdominales. Consideraciones diagnóstico-terapéuticas y revisión de la literatura.

The authors review the literature, discuss clinical aspects and options in the management of desmoid tumors, analyze recent advances in the understanding of its biology and how they affect therapeutic choices, and outline future treatment perspectives. We conclude that although recurrence rates are high, wide excision is the best firs approach. If it is not possible, marginal surgery and radiation therapy can be performed. Radiation therapy can be also use in the attempt to control recurrent disease. Although many pharmacologic agents have been advocated there is no clear proof of their usefulness. Systemic therapy may be considered for selected patients that are not amenable to local treatment.

[Transplantation in orthopedic surgery and traumatology]. / Los trasplantes en cirugía ortopédica y traumatología.

Clinical applications of the musculoskeletal system tissue bank are currently enlarging in areas such as tumour surgery, spine surgery and arthrodesis, reconstructive procedures of the hip joint and ligament repair. We report our experience about the use of more than 1,000 grafts utilize from 1987 to 1992. We concluded that a bone bank or a musculoskeletal system tissue bank has a great usefulness in different reconstructive surgery technics and arthrodesis. They are used more frequently in orthopaedic and traumatology surgery improving the development of this surgery.

Bacterial contamination of allografts.

The risk of bacterial infection through allogenic bone transplantation is one of the major problems facing tissue banks. The purpose of this study is to report the contamination rate in 987 grafts obtained under strictly aseptic conditions, between 1989 and 1992. The grafts were stored at -80 degrees C (cortical bone and tendons) and -40 degrees C (cancellous bone). The overall contamination rate was 6.6%, with Gram-positive bacteria responsible for 80% of the positive cultures. We discuss the sources of contamination, the most frequently isolated bacteria and the steps in the donation and transplantation procedures that help to reduce the risk of contamination. We conclude that the methods of acquisition, processing and storage of tissues are effective in making sterile allografts available.

Bacterial contamination of allografts.

The risk of bacterial infection through allogeneic bone transplantation is one of the problems facing tissue banks. The purpose of this study is to report the contamination rate in 987 grafts obtained under strictly aseptic conditions, between 1989 and 1992. The grafts were stored at -80 degrees C (cortical bone and tendons) and -40 degrees C (cancellous bone). The overall contamination rate was 6.6%, with Gram-positive bacteria responsible for 80% of the positive cultures. We discuss the sources of contamination, the most frequently isolated bacteria and the steps in the donation and transplantation procedures that help to reduce the risk of contamination. We conclude that the methods of procurement, processing and storage of tissues are effective in making sterile allografts available.