Total thumb carpometacarpal arthroplasty for failed trapeziometacarpal joint arthrodesis.

Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications.

Vascularized humeral periosteal flap to treat lateral humeral condyle nonunion: An anatomical study and report of two successfully-treated pediatric cases.

PURPOSE: Nonunion is a common complication of lateral condyle humeral (LCH) fractures in children. In situ fixation with a screw and bone grafting is the classically-recommended method of treatment. The purpose of this study is to analyze the feasibility of obtaining a vascularized periosteal flap obtained from the lateral humerus and based on the posterior collateral radial vessels (PCRV). Second, to report the results after the application in two pediatric cases. METHODS: Periosteal branches of PCRV were studied in ten upper limbs from fresh human cadavers. Then, two children with LCH nonunion were treated with this flap. RESULTS: The PCRV provided mean of 5.3 anterior periosteal branches (range 4-7) with a mean distance between them of 19.1 mm (range 5-29 mm) and 5.7 posterior periosteal branches (range 3-7) with a mean distance between them of 15.9 mm (range 6-33 mm. PCRV distally anastomosed to the interosseous recurrent artery and the radial recurrent artery, creating a vascular net over the lateral condyle and allowing for the design of a reverse vascularized humeral periosteal flap (VHPF). Abundant periosteal callus and rapid consolidation were achieved in both children. No bone fixation or grafting was necessary. CONCLUSIONS: VHPF might be considered a viable biological surgical option to promote bone healing in LCH nonunions in children, while avoiding the need for bone fixation and the donor morbidity associated with bone grafting.

¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia / Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre

Objetivo. Conocer los resultados del tratamiento quirúrgico de las fracturas de extremidad inferior en los pacientes con lesiones medulares crónicas. Material y método. Entre el 2003-2012 se trataron 37 fracturas de extremidad inferior, divididas en 2 grupos según su tratamiento, 25 en el grupo quirúrgico y 12 en el grupo conservador. Resultados. El grupo quirúrgico presentó mejores resultados en cuanto a balance articular, consolidación ósea, alineación radiológica y menor número de úlceras por presión. No se detectaron diferencias entre grupos en cuanto a estancia hospitalaria, número de complicaciones médicas y control del dolor. Discusión. Actualmente no hay consenso respecto al manejo de las fracturas de extremidad inferior en lesionados medulares crónicos, pero la tendencia ha sido el tratamiento conservador escudándose en la alta tasa de complicaciones del tratamiento quirúrgico. Conclusiones. En fracturas de extremidad inferior en lesionados medulares crónicos, la estabilización quirúrgica presenta mejores resultados de consolidación ósea, un balance articular prácticamente libre, una baja tasa de complicaciones cutáneas y dolor asociado a la fractura. Todo ello permite un rápido retorno al nivel previo de la lesión, por lo que se debe tener en cuenta como alternativa al tratamiento conservador (AU)

Objective. To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. Material and method. A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. Results. Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. Discussion. There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. Conclusions. Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients (AU)

Should lower limb fractures be treated surgically in patients with chronic spinal injuries? Experience in a reference centre. / ¿Se deben tratar quirúrgicamente las fracturas de extremidad inferior en pacientes con lesiones medulares crónicas? Experiencia en un centro de referencia.

OBJECTIVE: To report the outcomes of surgical treatment of lower limb fractures in patients with chronic spinal cord injuries. MATERIAL AND METHOD: A total of 37 lower limb fractures were treated from 2003 to 2010, of which 25 fractures were treated surgically and 12 orthopaedically. RESULTS: Patients of the surgical group had better clinical results, range of motion, bone consolidation, and less pressure ulcers and radiological misalignment. No differences were detected between groups in terms of pain, hospital stay, and medical complications. DISCUSSION: There is no currently consensus regarding the management of lower limb fractures in patients with chronic spinal cord injuries, but the trend has been conservative treatment due to the high rate of complications in surgical treatment. CONCLUSIONS: Chronic spinal cord injuries patients with lower limb fractures who are treated surgically achieved a more reliable consolidation, practically a free range of motion, low rate of cutaneous complications, and pain associated with the fracture. This allows a quick return to the previous standard of living, and should be considered as an alternative to orthopaedic treatment in these patients.