Utilización de aloinjerto estructural en los defectos óseos durante la colocación de una prótesis total de codo: dos casos clínicos / Use of strut grafts in bone defects when placing a total elbow: two case reports

Introducción. Los defectos óseos que aparecen en el momento de un recambio de una prótesis de codo, o tras la mala evolución de una fractura supraintercondílea, en el momento de colocar una prótesis de codo, pueden ser solucionados con un implante de hueso de banco. Casos clínicos. Presentamos dos casos en los que se ha usado aloinjerto estructural en la colocación de una prótesis total de codo, uno en localización humeral y otro cubital. Resultados. Los dos resultados clínicos obtenidos con 24 y 26 meses de seguimiento, utilizando la escala de Mayo Elbow Performance Score, han sido uno de regular y uno de excelente. Conclusiones. La utilización de aloinjerto de banco es un recurso útil para el tratamiento de los grandes defectos óseos en la colocación de una prótesis total de codo

Introduction. Bone defects that become visible during total elbow revision surgery or further to poor evolution of a supraintercondylar fracture can be addressed by means of an implant of bone-bank origin. Case reports. We present two cases in which strut grafts were used when placing a total elbow prosthesis, one at the humeral and the other at the ulnar level. Results. The clinical results for these grafts, one at 24 and the other at 26 months' follow-up, were fair and excellent respectively, according to the Mayo Elbow Performance Score. Conclusions. The use of a bone-bank allograft is a useful way of treating the large bone defects that may appear when placing a total elbow prosthesis

[Palliative surgical treatment of spastic paralysis in the upper extremity]. / Cirugía paliativa de la parálisis espástica en las extremidades superiores.

AIMS: In this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity. DEVELOPMENT: Spasticity presents muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motoneuron syndrome. Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, paediatricians, orthopaedic surgeons and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, and the deformity of the fingers (swan-neck and thumbs-in-palm). The primary objectives in these patients will be to improve communication with their surroundings, perform activities of daily living, increase mobility and walking. CONCLUSIONS: The surgical treatment applied by orthopaedic surgeons in the upper extremities are aimed at achieving an enhanced adaptive functionality rather than morphological normality. Factors to be taken into account include age, voluntary control over muscles and joints, level of severity of the spasticity (Ashworth scale) and stereognostic sensitivity. In general, on soft parts we will use procedures such as dehiscence or lengthening of the flexor muscles of the shoulder and elbow or of the adductor of the thumb; transfer of the pronators in order to adopt the supinating function or of the flexors so as to reinforce the extensors of the forearm, and capsulodesis or tenodesis in the hand. The bony procedures will consist in derotational osteotomies of the humerus and radius and arthrodesis in the wrist or in the metacarpophalangeal joints of the thumb, depending on whether there is greater rigidity or age in the former cases or instability in the latter.

Cirugía paliativa de la parálisis espástica en las extremidades superiores / Palliative surgical treatment of spastic paralysis inthe upper extremity

Objetivo. En el presente trabajo se revisan los principales estudios de las aplicaciones terapéuticas sobre las partes óseas y las partes blandas en la parálisis espástica de las extremidades superiores. Desarrollo. La espasticidad se presenta con hipertonía muscular e hiperexcitabilidad del reflejo de estiramiento, típicos del síndrome de la motoneurona superior. Fisiopatológicamente, la espasticidad se debe a la alteración de las vías aferentes y eferentes medular y supramedularmente. Su tratamiento es multidisciplinar: intervienen, fundamentalmente, rehabilitadores, neurofisiólogos, neurólogos, pediatras, cirujanos ortopédicos y psicólogos, que aportan sus distintos enfoques y sus características terapéuticas (tratamiento farmacológico, bloqueos neurológicos periféricos y quirúrgico, etc.). La postura característica de las extremidades superiores en la parálisis cerebral espástica es la rotación interna del hombro, la flexión del codo y la pronación del antebrazo, y la deformidad de los dedos (cuello de cisne y pulgares en palma). Los objetivos prioritarios en estos pacientes serán mejorar su comunicación con el entorno, que realicen actividades de la vida diaria e incrementar su movilidad y deambulación. Conclusiones. Los tratamientos quirúrgicos que aplican los cirujanos ortopédicos en las extremidades superiores pretenden, más que la normalidad morfológica, una mejor funcionalidad adaptativa. Son factores a considerar la edad, el control voluntario muscular y de las articulaciones, la gravedad de la espasticidad (escala de Ashworth) y la sensibilidad estereognósica. En general, utilizaremos procedimientos sobre las partes blandas, como la desinserción o el alargamiento de los músculos flexores del hombro y el codo o del aductor del pulgar; transferencia de los pronadores para adoptar función supinadora, o de los flexores para potenciar los extensores en el antebrazo, y capsulodesis o tenodesis en la mano. Los procedimientos óseos consistirán en osteotomías desrotadoras del húmero y el radio y artrodesis en la muñeca o en la articulación metacarpofalángica del pulgar, según existan mayor rigidez o más edad en los primeros casos o inestabilidad en el último (AU)

Aims. In this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity. Development. Spasticity presents muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motoneuron syndrome. Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, paediatricians, orthopaedic surgeons and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, and the deformity of the fingers (swan-neck and thumbs-in-palm). The primary objectives in these patients will be to improve communication with their surroundings, perform activities of daily living, increase mobility and walking. Conclusions. The surgical treatment applied by orthopaedic surgeons in the upper extremities are aimed at achieving an enhanced adaptive functionality rather than morphological normality. Factors to be taken into account include age, voluntary control over muscles and joints, level of severity of the spasticity (Ashworth scale) and stereognostic sensitivity. In general, on soft parts we will use procedures such as dehiscence or lengthening of the flexor muscles of the shoulder and elbow or of the adductor of the thumb; transfer of the pronators in order to adopt the supinating function or of the flexors so as to reinforce the extensors of the forearm, and capsulodesis or tenodesis in the hand. The bony procedures will consist in derotational osteotomies of the humerus and radius and arthrodesis in the wrist or in the metacarpophalangeal joints of the thumb, depending on whether there is greater rigidity or age in the former cases or instability in the latter (AU)

Femoral head necrosis after intertrochanteric fracture: a case report after synthesis with Ender nails.

A case of femoral head necrosis in a patient who suffered an intertrochanteric fracture, treated with Ender nails 1 year before, is presented. The rarity, and possible mechanisms (reduction and type of osteosinthesis) of necrosis are discussed.

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.