Luxación de codo con fractura ipsilateral del extremo distal del radio asociada a lesión de la arteria braquial. Una nueva entidad patológica de origen traumático / Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: a new pathological condition of traumatic origin

La luxación de codo asociada a fractura ipsilateral del radio distal y lesión de la arteria braquial constituye una patología traumática infrecuente. Las 2 referencias de esta asociación de lesiones aparecieron en 2015, aunque en ambas, los autores no advirtieron que constituían los 2 primeros casos publicados en la literatura médica; incluso en el título de sus artículos, no se hizo mención de la fractura del extremo distal del radio, pero sí en sus textos. El objeto de este trabajo es dar a conocer 3 casos con esta nueva entidad patológica traumática, explicar su posible mecanismo patogénico, el tratamiento utilizado y los resultados obtenidos (AU)

Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained (AU)

Elbow dislocation with ipsilateral fracture of the distal radius associated with a brachial artery injury: A new pathological condition of traumatic origin. / Luxación de codo con fractura ipsilateral del extremo distal del radio asociada a lesión de la arteria braquial. Una nueva entidad patológica de origen traumático.

Elbow dislocation associated with ipsilateral fracture of the distal radius and a brachial artery injury is an uncommon traumatic entity. The two references of this injury combination appeared in 2015, although both authors did not realise that they were the first two cases published in the medical literature. Although mentioned in the text of the articles, no mention was made of the fracture of the distal radius in the titles. The purpose of this paper is to present three cases with this new traumatic pathological entity, explaining its pathogenetic mechanism, the treatment used, and the results obtained.

Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF.

INTRODUCTION: Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. PATIENTS AND METHODS: A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. RESULTS: Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). CONCLUSION: Patients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. LEVEL OF EVIDENCE: Level IV therapeutic; retrospective comparative study.

Tratamiento de la inestabilidad acromioclavicular crónica / Treatment of chronic acromioclavicular joint instability

Valorar los resultados de la técnica quirúrgica asistida por artroscopía indicada para el tratamiento de la inestabilidad acromioclavicular crónica (IAC), basada en la fijación coracoclavicular (CC) no-rígida más reconstrucción CC anatómica con aloinjerto tendinoso. Se incluyó a los pacientes con IAC intervenidos entre 2008 y 2012. Las valoraciones clínicas se realizaron mediante el SF36, la EVA y el DASH, aplicados en la visita previa (VPI) a la intervención y en la última visita de seguimiento (UVS). El Constant score y la Escala de Satisfacción General (0-10) se aplicaron en la última visita de seguimiento. Se valoró el desarrollo de subluxaciones secundarias. Se incluyeron 10 pacientes. Edad media 41 años [rango 33-55]. Seguimiento medio 25.50 meses [rango 24-30].En todos los pacientes el tratamiento quirúrgico se indicó cuando el tratamiento conservador fracasó. Cuestionarios aplicados en la VPI y en la UVS: 1. SF36 físico: VPI 29.60 ± 3.41 y UVS 59.58 ± 1.98 (p = 0.000); 2. SF36 mental: VPI 46.57 ± 3.80 y UVS 56.62 ± 1.89 (p = 0.000); 3. EVA: VPI 5.17 ± 2.40 y UVS 1.67 ± 2.07 (p = 0.022); y 4. DASH: VPI 63.33 ± 23.56 y UVS 2.61 ± 1.79 (p = 0.000). El Constant score y la satisfacción general de la UVS fueron 95.56 ± 3.28 y 9.22 ± 0.67 respectivamente. No hubo subluxaciones secundarias. El tratamiento de la IAC mediante un dispositivo de suspensión CC y una reconstrucción anatómica de los ligamentos CC asistida por artroscopía, puede ofrecer una mejoría significativa de la calidad de vida de los pacientes y representa una estrategia que al contemplar una fijación CC mecánica primaria, puede minimizar las posibilidades de fracaso y desarrollo de subluxaciones secundarias.

The purpose of this paper is to assess the results obtained with the arthroscopy-assisted surgical technique for the treatment of chronic acromioclavicular joint instability (CACJI), based on non-rigid coracoclavicular (CC) fixation and anatomical CC reconstruction with a tendinous allograft. Patients with CACJI who underwent surgery between 2008 and 2012 were included in the study. Clinical assessments included SF36, VAS and DASH, applied at the preoperative visit (POV) and at the last follow-up visit (LFUV). The Constant score and the General Satisfaction Score (0-10) were applied at the last follow-up visit. Occurrence of secondary subluxations was assessed. Ten patients were included; mean age was 41 years (range 33-55). Mean follow-up was 25.50 months (range 24-30). Surgical treatment was indicated in all patients after failure of conservative treatment. Questionnaires applied at the POV and the LFUV showed the following results: 1. SF36: physical, POV = 29.60 ± 3.41 and LFUV = 59.58 ± 1.98 (p = 0.000); 2. SF36 mental, POV = 46.57 ± 3.80 and LFUV = 56.62 ± 1.89 (p = 0.000); 3. VAS: POV = 5.17 ± 2.40 and LFUV: 1.67 ± 2.07 (p = 0.022); and 4. DASH: POV = 63.33 ± 23.56 and LFUV = 2.61 ± 1.79 (p = 0.000). The Constant score and the general satisfaction at the LFUV were 95.56 ± 3.28 and 9.22 ± 0.67, respectively. There were no secondary subluxations. Treatment of CACJI with a CC suspension device and arthroscopically-assisted anatomical reconstruction of CC ligaments may provide a significant quality of life improvement to patients. It is a strategy that, upon considering primary mechanical CC fixation, may minimize the chance of failure and occurrence of secondary subluxations.

[Treatment of chronic acromioclavicular joint instability]. / Tratamiento de la inestabilidad acromioclavicular crónica.

The purpose of this paper is to assess the results obtained with the arthroscopy-assisted surgical technique for the treatment of chronic acromioclavicular joint instability (CACJI), based on non-rigid coracoclavicular (CC) fixation and anatomical CC reconstruction with a tendinous allograft. Patients with CACJI who underwent surgery between 2008 and 2012 were included in the study. Clinical assessments included SF36, VAS and DASH, applied at the preoperative visit (POV) and at the last follow-up visit (LFUV). The Constant score and the General Satisfaction Score (0-10) were applied at the last follow-up visit. Occurrence of secondary subluxations was assessed. Ten patients were included; mean age was 41 years (range 33-55). Mean follow-up was 25.50 months (range 24-30). Surgical treatment was indicated in all patients after failure of conservative treatment. Questionnaires applied at the POV and the LFUV showed the following results: 1. SF36: physical, POV = 29.60 ± 3.41 and LFUV = 59.58 ± 1.98 (p = 0.000); 2. SF36 mental, POV = 46.57 ± 3.80 and LFUV = 56.62 ± 1.89 (p = 0.000); 3. VAS: POV = 5.17 ± 2.40 and LFUV: 1.67 ± 2.07 (p = 0.022); and 4. DASH: POV = 63.33 ± 23.56 and LFUV = 2.61 ± 1.79 (p = 0.000). The Constant score and the general satisfaction at the LFUV were 95.56 ± 3.28 and 9.22 ± 0.67, respectively. There were no secondary subluxations. Treatment of CACJI with a CC suspension device and arthroscopically-assisted anatomical reconstruction of CC ligaments may provide a significant quality of life improvement to patients. It is a strategy that, upon considering primary mechanical CC fixation, may minimize the chance of failure and occurrence of secondary subluxations.

Estudio de la movilidad meniscal con TAC en prótesis totales de rodilla con soportes móvilesde polietileno / CT scan study of meniscal mobility in total knee prostheses with mobile polyethylene components

Objetivo. Analizar la movilidad meniscal mediante tomografía axial computarizada (TAC) en prótesis total de rodilla con meniscos móviles de polietileno. Material y método. Quince prótesis con un seguimiento mínimo de 24 meses fueron sometidas a un estudio con TAC funcional para determinar la movilidad meniscal con movimientos de extensión, flexión y rotación axial de la rodilla. Se analizó la cinemática articular y el grado de desplazamiento de los soportes meniscales con el sistema digital de medición GP-9 Sonic Digitizer. Resultados. Observamos desplazamiento de los soportes meniscales en todos los casos analizados. El menisco interno se desplazó un promedio de 4,5 mm (mínimo 1 mm y máximo 9,5 mm) y el menisco externo 5 mm (1,1 mínimo y 11,6 máximo). El grado de movimiento fue mayor en el compartimento externo (p = 0,19) y durante la rotación axial (p = 0,09). Se vieron dos tipos básicos de movimiento; en 12 artroplastias (80 por ciento) el movimiento meniscal se aproximaba al desplazamiento de los meniscos de una rodilla normal; en el resto, se produjo un movimiento anómalo anterior de los meniscos al realizar la flexión de rodilla, sin relación con inestabilidad ligamentosa (p > 0,05) ni repercusión funcional aparente. Conclusiones. El movimiento meniscal se conservó a medio plazo, siendo similar al de una rodilla normal en la mayoría de las artroplastias estudiadas. (AU)

Reemplazo rotuliano sistemático en 335 artroplastias totales de rodilla / Systematic patellar replacement in 335 total knee arthroplasties

Objetivo: Ante la controversia existente en relación con el reemplazo rotuliano en las prótesis totales de rodilla, se pretende cuantificar la morbilidad que esta sustitución tiene.Diseño experimental: El estudio retrospectivo de los fracasos del componente patelar (reintervenciones debidas exclusivamente a problemas relacionados con la patela) en una serie, donde el reemplazo patelar se llevó a cabo de manera sistemática.Material y método: 335 artroplastias de diversos diseños fueron colocadas por el mismo cirujano o bajo su directa supervisión. El seguimiento medio fue de 7,3 años.Resultados: Hubo 7 fracasos del componente patelar (2,08 por ciento), debido a: 2 subluxaciones, 3 fracturas patelares, una disociación del implante y un caso de fibrosis peripatelar. Los gestos quirúrgicos realizados fueron: realineacion proximal en el caso de las subluxaciones, patelectomía en las fracturas y en el caso de la disociación del implante, y exéresis del tejido fibroso en el caso de la fibrosis peripatelar. El índice de fracasos no mostró relación estadísticamente significativa ni con el modelo protésico (Chi cuadrado; p = 0,15) ni con el diagnóstico de base (Chi cuadrado; p = 0,64).Conclusiones: Considerando la baja incidencia de complicaciones obtenida y las ventajas clínicas y biomecánicas que supone, el reemplazo patelar sistemático en las prótesis totales de rodilla, llevado a cabo con una técnica meticulosa, supone un riesgo perfectamente asumible (AU)