Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis / Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

[Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término / Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis

Introduction: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. Description of technique: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. Patients and methods: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. Results: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. Conclusions: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.(AU)

Introducción: La artroplastia con reconstrucción ligamentosa e interposición tendinosa (LRTI, en inglés) es el procedimiento de elección para tratar la rizartrosis. El colapso progresivo tras la trapeciectomía es un problema habitual. Descripción de la técnica: Realizamos una LRTI con el hemitendón del flexor carpis radialis (FCR) y, posteriormente, colocamos un fragmento óseo en la base del metacarpo para bloquear la plastia. Esta técnica nos permite obtener estabilidad inmediata y mantener la tensión. Método: Presentamos un estudio observacional longitudinal retrospectivo unicéntrico, que incluye a 51 pacientes con diagnóstico de rizartrosis sintomática. Los pacientes se dividieron en 2 grupos: grupo A, pacientes intervenidos mediante trapeciectomía con LRTI del FCR según la técnica de Burton-Pellegrini y grupo B, pacientes intervenidos mediante la técnica modificada. Se analizó la altura del espacio escafometacarpiano (EM) restante en radiografías postoperatorias. Se valoraron los resultados clínicos, como la oposición o retroversión del pulgar, satisfacción del paciente y tiempo quirúrgico. Resultados: Las diferencias en altura del espacio EM a uno y 6 meses tras la cirugía son significativamente menores con la técnica modificada (p=0,033 y p=0,001, respectivamente). La pérdida de altura media del espacio EM del primer al sexto mes tras la cirugía fue menor en el grupo B, con mayor estabilidad de la plastia. Conclusión: El uso de un fragmento óseo para bloquear la plastia del FCR mejora los resultados clínicos y radiológicos a uno y 6 meses tras la cirugía, con menor pérdida de altura del espacio EM y mejoría de la oposición del pulgar, sin aumentar el tiempo quirúrgico.(AU)

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (p=0.033 and p=0.001 respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Modification of Burton and Pellegrini trapeziectomy technique: Medium-term comparative analysis. / [Artículo traducido] Modificación de la técnica de trapeciectomía de Burton-Pellegrini: análisis comparativo a medio término.

INTRODUCTION: Ligament reconstruction and tendon interposition (LRTI) arthroplasty is the procedure of choice of most hand surgeons in the treatment of basal joint arthritis of the thumb. Progressive and natural collapse after trapeziectomy is a common problem. DESCRIPTION OF TECHNIQUE: We performed LRTI with flexor carpi radialis (FCR) hemitendon technique, then proceeded to block the hemitendon plasty with a bone fragment at the base of the metacarpal. This technique allows us to maintain tension and to obtain immediate stability. PATIENTS AND METHODS: We conducted a single-center retrospective longitudinal observational study including 51 patients with diagnosis of symptomatic osteoarthritis of the trapeziometacarpal joint. Group A consisted of 24 thumbs treated with trapeziectomy with LRTI with FCR hemitendon using the Burton-Pellegrini technique. Group B included 27 thumbs treated using the modified technique. The postoperative height of the Scaphometacarpal (SM) space was analyzed. Clinical outcome, opposition, retroversion, patient satisfaction and surgical timing were studied. RESULTS: The difference of the SM space, after applying correction factor, at one and six months postoperative is significantly less in the modified technique group (P = .033 and P = .001, respectively). The average height loss of the SM space from one to six months postoperative measurement was smaller in the study group, showing greater stability of the plasty. CONCLUSIONS: The use of a bone fragment to block the FCR plasty improves the results at one and six months postoperatively, showing a diminished height loss of the SM space, improved thumb opposition and without prolonging surgical timing in our series.

Resultados funcionales en artroplastia total de codo / Functional outcome total elbow arthroplasty

Introducción. La artroplastia total de codo (ATC) está indicada en pacientes que presentan dolor incapacitante y limitación funcional severa, en los que no es posible realizar otra técnica quirúrgica que conserve la movilidad. El objetivo de nuestro trabajo es valorar los resultados clínicos y funcionales de las ATC realizadas en el Hospital Clínic de Barcelona en los últimos 10 años (enero de 1999–enero de 2009). Pacientes y métodos. Estudio descriptivo transversal que incluye a 25 pacientes. Se analizan variables demográficas (edad y sexo), clínicas (etiología, dolor, balance articular y balance muscular) y resultados funcionales medidos con la escala de Mayo Elbow Performance Index y el cuestionario Disabilities of the Arm, Shoulder and Hand. Resultados. Edad media de 63,7 años (DE 11,9); el 68,42% eran mujeres. Como principales etiologías encontramos artritis reumatoide (35%), artrosis primarias (20%) artrosis postraumática (35%) y otras causas (10%). La puntuación media de dolor fue de 2,78 (DE: 2,01) en la escala visual analógica. El balance articular medio encontrado fue de −33,42° de extensión (DE: 23,86), 125,26° de flexión (DE: 24,76), 86,3° de pronación (DE: 11,65) y 72,36° de supinación (DE: 26,47). El balance muscular medio en newtons fue de 27,98 para la extensión (DE: 19,06), de 78,72 para la flexión (DE: 49,62) y una fuerza de garra de 33,82 pounds (DE: 21,01). Se obtuvo una puntuación media de 76,7 (DE: 16,3) en la escala de Mayo Elbow Performance Index y una puntuación media de 78,5 (DE: 28,9) en el cuestionario Disabilities of the Arm, Shoulder and Hand. Conclusiones. La ATC proporciona, respecto a otras técnicas quirúrgicas, un buen rango de movilidad y funcionalidad para las actividades básicas de la vida diaria, así como mejoría de la sintomatología dolorosa (AU)

Introduction. Total elbow arthroplasty (ATC) is indicated in patients with disabling pain and severe functional limitation, which is not possible another surgical technique that preserves the mobility. The objetive of our work is to evaluate the clinical and functional results of the ATC at the Hospital Clinic of Barcelona in the last 10 years (January 1999–January 2009). Patients and methods. Cross-sectional study including 25 patients. We analyzed demographic variables (age and sex), clinical (etiology, pain, joint of motion and muscular streng) and functional outcome measured with the MEPI scale (Mayo Elbow Performance Index) and the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand). Results. Mean age 63,7 (11,9) years, 68,42% women. As main etiologies found rheumatoid arthritis (35%), primary osteoarthritis (20%), postraumatic osteoarthritis (35%) and other causes (10%). The mean pain score was 2,78 (SD 2,01) in the visual analogue scale. The average joint stock was found: −33,42° (SD 23,86) in length, 125,26° (SD 24,76) of flexion, 86,3° (DE11,65) of pronation, 72,36° (SD 26,47) of supination. The muscular strengt in Newtons was 27,98 (of 19,06) for extension, 78,72 (OF 49,62) for flexion and a force of Paw Pounds 33,82 (SD 21,01). We obtained a mean score of 76,7 (SD 16,3) in the MEPI scale and 78,5 (SD 28,9) in the DASH questionnaire. Conclusions. Total elbow arthroplasty provides over other surgical techniques, a good range of motion and functionality to the basic activities of daily living, like this as it improves the pain (AU)

Enclavado de Hackethal modificado en las fracturas transversales del tercio medio del húmero / Modified Hackethal nailing in transversal fractures of the middle third of the humerus

Se analiza retrospectivamente una serie de 84 casos de fracturas transversales del tercio medio del húmero tratados por enclavado en haz de Hackethal modificado. Cuarenta y ocho pacientes eran varones y 36 mujeres, siendo la edad media de 46,2 años. El seguimiento postoperatorio medio fue de 2,5 años. Se revisan las complicaciones inmediatas y tardías de las fracturas, entre las que destacan las migraciones proximales (6 por ciento) y distales de las agujas (10,7 por ciento), las angulaciones del material (3,6 por ciento), la rotura del material (2,45) y las seudoartrosis (3,6 por ciento). Varias complicaciones pueden ocurrir en un mismo paciente, especialmente se han observado las asociaciones: migraciones distales con infecciones superficiales, el edema con la desviación y la diástasis del foco con la seudoartrosis. La tasa de infección es baja, siendo todas superficiales (2,4 por ciento); no se ha observado ningún caso de parálisis radial postoperatoria. Por la facilidad de ejecución y por los buenos resultados obtenidos el enclavado de Hackethal modificado es un método eficaz para el tratamiento de las fracturas diafisarias del tercio medio del húmero (AU)

Treatment of Galeazzi fracture-dislocations.

Among 33 patients with a Galeazzi-type fracture-dislocation of the forearm, there were two children and 26 adults with a classic Galeazzi injury, and five patients with a Galeazzi-equivalent lesion. The worst results were obtained in type-I lesions. Closed reduction was primarily successful in children. The results of surgical treatment were much better in adults. It is advisable to treat this complex injury by anatomic reduction and internal fixation of the radial shaft fracture. Immobilization in a fully supinated position is recommended to reduce the dislocation of the distal radioulnar joint. Additional temporary radioulnar fixation with Kirschner wires is also necessary in cases of severe derangement of the distal radioulnar joint.

Osteochondritis dissecans of the patella. 12 cases followed for 4 years.

Osteochondritis dissecans of the patella in 9 patients (6 men, 3 women; mean age 19 years) was located in the median ridge and paramedial areas and was bilateral in 3 patients. All patients were initially treated conservatively with complete relief of symptoms in 5. In 7 patients fragments were excised and the crater was curetted and drilled. At follow-up after 4 (2-8) years, the patients had no restriction of activities and they had no pain.