[Translated article] Experience in major complications with total trapezometacarpal prostheses.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.

Experience in major complications with total trapezometacarpal prostheses. / Experiencia en complicaciones mayores con las prótesis totales trapeciometacarpianas.

INTRODUCTION: The treatment of rhizarthrosis using trapeziometacarpal prostheses (TMP) is increasing. Complications may lead to loss of the implant and result in salvage surgery. Our aim was to assess major complications with the use of some TMP models and their rescue. MATERIAL AND METHOD: Retrospective study on TMP implanted between 2006 and 2021. Models studied: Arpe®, Elektra®, Ivory®, Maïa®, Isis® and Touch®. Demographic data were assessed, implant placement by radiographic study, technical data, complications, salvage surgeries and final survival. RESULTS: Review of 224 TMP, 45 Arpe® (95.5% survival, rate follow-up [R] 6-16 years), 5 Elektra® (80% survival, R 13-14), 14 Ivory® (92.8% survival, R 9-11), 7 Maïa® (100% survival, R 8-9), 115 Isis® (99.1% survival, R 1-8), 38 Touch® (100% survival, R 1-4). The medial angle of the dome with the proximal articular surface of the trapezium in the lateral plane, was: Arpe®: 8.85°, Elektra®: not assessable, Ivory®: 6.6°, Maïa®: 14.4°, Isis®: 3.8°, and Touch®: 5.95°. The Isis® was placed 100% with scopic guidance presenting a significantly lower angle respect to the medial angle of the dome with the proximal articular surface of the trapezium. As main complications, we observed 3.5% of dislocations and 4% of mobilisations, with the Elektra® being responsible for 47% of these. Nineteen salvage surgeries were performed, with 3% of the implants being lost. CONCLUSIONS: Dislocation and mobilisation are the most observed complications, the Elektra® responsible for almost half of them. Correct placement and implant design appear to be crucial to avoid them in the short and long term.

Initial survival of the Isis® total trapeziometacarpal prosthesis with conical trunk threaded cups. / Supervivencia inicial de la prótesis total trapeciometacarpiana de cúpula roscada Isis®.

INTRODUCTION: The treatment of trapeziometacarpal osteoarthritis through the implantation of total trapeziometacarpal prostheses is in continuous expansion. The Isis® prosthesis is a trunk-conical threaded anchorage prosthesis. Our objective was to assess the functional results and survival of this implant for at least one year of follow-up. MATERIAL AND METHOD: Prospective study on 53 Isis® prosthesis, implanted from april 2014 to january 2019. The Van Cappelle functional test, pain, strength, mobility, return to previous activity, radiological variables and placement of the trapezial component were evaluated. The surgical technique was performed with a guide wirefocused on the trapezius and control of the scopia. Observed complications were recorded and statistical analysis was performed. RESULTS: Fifty-one implants (49 patients) were reviewed. Mean follow-up was 2.1 years (1-5.7). Van Cappelle's test, pain, mobility, and grip and clamp strength improved significantly, as did the distance between the metacarpal head and the trapezius base; 96% of the patients returned in less than 6 months to their activities. Minor complications, 3 De Quervain's tendinopathy and 2 intra-operative metacarpal and 2 trapezium fractures were recorded, and one carpal tunnel syndrome. There was no dislocation, mobilization, or implant infection. CONCLUSIONS: The functional results of the Isis® prosthesis are excellent in the short term, far exceeding the first year of 100% of survival. The complications that arose were minor and few. The anchorage and placement of the trapezial component guided by scopia seem to be crucial for the good result.

Rehabilitación domiciliaria en el tratamiento postoperatorio de la reparación de los tendones flexores / Home-based rehabilitation in the postoperative treatment of flexor tendon repair

Objetivo. Evaluar resultados y complicaciones de la reparación de tendones flexores en un programa de rehabilitación domiciliario sin la asistencia de un terapeuta de mano durante las primeras 4semanas postoperatorias. Material y métodos. Entre julio de 2009 y julio de 2014, un total de 21 dedos en 15 pacientes fueron tratados en nuestro centro por una lesión completa de tendones flexores en la zona del sistema de poleas (zonas 1 y 2). Ejercicios pasivos y activos de rehabilitación, ejecutados por el propio paciente, se empezaron la mañana siguiente a la operación. Los datos de movilidad y complicaciones fueron recogidos 6meses después de la intervención. Resultados. Quince dedos tuvieron recuperación completa de la flexión. Un paciente sufrió una rotura en la quinta semana postoperatoria. En 10 de los 21 dedos se presentó una contractura en flexión de la articulación interfalángica proximal; en 5 la contractura fue de 10° o menos, sin afectar la función ni la estética. Discusión. La terapia de mano especializada ha sido de gran importancia en el tratamiento postoperatorio de las dolencias de la mano. Desafortunadamente, en nuestro medio, es frecuente que estos profesionales no estén disponibles en los primeros días tras la intervención. Con este protocolo, el paciente asume la responsabilidad en la ejecución de los ejercicios, lo que podría conllevar un peor resultado final y un aumento en la tasa de roturas. Conclusión. El programa de rehabilitación domiciliaria proporcionó la recuperación completa de la movilidad articular en la mayoría de los casos, con un bajo número de complicaciones (AU)

Objective. To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. Material y methods. Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. Results. Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. Discussion. Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. Conclusion. The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate (AU)

Home-based rehabilitation in the postoperative treatment of flexor tendon repair. / Rehabilitación domiciliaria en el tratamiento postoperatorio de la reparación de los tendones flexores.

OBJECTIVE: To evaluate the results and complications of flexor tendon repair in which a home-based rehabilitation program was utilized without the assistance of a hand therapist during the first 4postoperative weeks. MATERIAL Y METHODS: Between July 2009 and July 2014, a total of 21 digits in 15 patients were treated in our institution for complete laceration of the flexor tendons within the flexor pulley system (zone 1 and 2). Passive and active exercises performed by the patients themselves were started the morning after the operation. Data, as range-of-motion and complications, were collected 6months after the surgery. RESULTS: Fifteen digits had full recovery of flexion. One patient suffered a rupture in the fifth postoperative week. Ten of the 21 digits developed a flexion contracture of the proximal interphalangeal joint; in 5 the contracture was less or equal to 10° without impairment of function or aesthetics. DISCUSSION: Over recent decades, specialized hand therapy has been of great importance in the postoperative treatment of hand diseases. Unfortunately, these professionals are not always available in our area in the first days after surgery. With this protocol, the patient is in charge of carrying out the postoperative exercises, which could lead to a worse final result and a higher rate of complications. CONCLUSION: The home-based rehabilitation program yielded complete recovery of joint mobility in most cases with a low complication rate.

Experiencia con el colgajo interóseo posterior: serie de casos / Experience with posterior interosseous flaps: a cases series

Objetivo. Se describen diez pacientes intervenidos para coberturas de heridas traumáticas y retracciones cicatriciales las cuales se realizaron con un colgajo interóseo posterior. Material y método. Diez pacientes consecutivos, que fueron programados para coberturas de heridas entre marzo de 2007 y abril de 2010, se revisaron retrospectivamente en cuanto a factores demográficos, etiología, localización de las heridas, dimensiones del colgajo, resultado final y complicaciones. Resultados. Se descartó un paciente por encontrarse variaciones anatómicas. De los nueve restantes, la supervivencia fue total en siete y parcial (pérdida del 10% de la extremidad opuesta al pedículo) en dos. En los tres primeros casos de la serie se apreció una congestión venosa leve a moderada que no comprometió el resultado final. Discusión. Es nuestra preferencia prescindir del uso de colgajos libres para disminuir el tiempo de intervención y evitar complicaciones derivadas de la realización de anastomosis. La incorporación de una vena subcutánea de gran calibre disecada con tejido subcutáneo realizada a partir del cuarto caso solucionó los problemas de edemas por congestión venosa. El injerto de piel parcial en la zona donante puede llevar a quejas estéticas. Conclusión. El colgajo interóseo posterior demostró ser una alternativa fiable y efectiva para cobertura de heridas que se localicen en el rango de alcance de su pedículo, a menos que se encuentren variaciones anatómicas, lo cual ocurre en pocos casos (AU)

Objectives. To describe 10 patients treated for traumatic wounds or scar tissue retraction with reversed pedicled posterior interosseous flaps. Material and methods. Ten consecutive patients, operated on for wound coverage between March 2007 and April 2010, were retrospectively reviewed in terms of demographic factors, etiology, wound location, flap dimensions, final outcome, and complications. Results. One patient was excluded due to anatomical variations. From the remaining nine patients, full flap survival was achieved in seven; partial survival (10% flap loss at the distal end opposite to the pedicle) was achieved in two. Slight to moderate venous congestion was observed in the three first patients of this series, but this did not affect the final outcome. Discussion. It is our preference to avoid the use of free flaps in order to decrease the operation time and to avoid complications related to the anastomosis technique. The addition of a large subcutaneous vein dissected with subcutaneous tissue, which we started in the fourth case, solved the problems related to edemas and venous congestion. Split thickness skin grafts on the donor area can lead to aesthetic complaints. Conclusion. Posterior interosseous flap was shown to be a reliable and effective alternative for wound coverage within the range of its pedicle, unless there are anatomical variations, which is not common (AU)