Artroplastia interfalángica proximal de dedo de la mano con doble injerto osteocondral de costilla. Reporte de un caso y descripción de la técnica quirúrgica / Proximal interphalangeal finger arthroplasty with double osteochondral rib graft. Case report and description of the surgical technique

Se presenta el caso de un hombre de 27 años con una lesión grave articular interfalángica proximal en el dedo anular de la mano derecha, provocada por un proyectil de arma de fuego, que fue tratada con doble injerto osteocondral de costilla. Tenía una fractura expuesta y déficit de stock óseo y cartilaginoso tanto en la primera como en la segunda falange. Luego de la limpieza inicial, a las 3 semanas, se realizó una artroplastia interfalángica proximal con doble injerto osteocondral de costilla y fijador externo distractor de Suzuki. Se describe con detalle la técnica quirúrgica.A las 10 semanas posoperatorias, la flexión activa interfalángica era de 75° y la extensión activa, de -15°, con articulación estable. Alta laboral a los 3 meses de la cirugía, sin dolor y un puntaje DASH de 14,2. Las radiografías mostraron la incorporación de los injertos, sin reabsorción y con una articulación congruente.Se valora la ventaja de esta técnica en cuanto a la escasa morbilidad para la zona dadora y la versatilidad para las reconstrucciones con defectos articulares. El resultado funcional temprano subjetivo y objetivo fue satisfactorio. No se pueden descartar complicaciones futuras. Nivel de Evidencia; IV

We present the case of a 27-year-old male patient with a gunshot wound and severe proximal interphalangeal joint injury in the ring finger of the right hand, treated with a double osteochondral rib graft. He had an exposed fracture and a lack of bone and cartilage stock in both the first and second phalanx. After the initial toilette, at 3 weeks, a proximal interphalangeal arthroplasty was performed with a double osteochondral rib graft protected by a Suzuki external distractor. The surgical technique is described in detail. At 10 weeks after surgery, an active interphalangeal joint flexion of 75° and active extension of -15° were verified, without articular instability. The patient returned to work at 3 months after surgery, with no residual pain (0 VAS score) and a DASH score of 14.2. Radiographs showed incorporated grafts without resorption and a congruent joint. This technique is valued for its low morbidity on the donor site and versatility for joint defect reconstructions. The limitations of our study are mentioned. The clinical case presented obtained a satisfactory subjective and objective early functional outcome. Further complications cannot be ruled out. Level of Evidence: IV

Rotura del bíceps distal: Evaluación de resultados con técnica de doble fijación

Introducción: La rotura del bíceps distal es una lesión poco frecuente producida por la aplicación de una fuerza excéntrica sobre el codo flexionado. El objetivo de este trabajo es analizar los resultados obtenidos para la reinserción del bíceps distal mediante técnica de doble fijación con botón de anclaje cortical y tornillo interferencial de biotenodesis a través de una incisión anterior única. Materiales y Métodos: Entre agosto de 2008 y febrero de 2013, registramos 19 casos de rotura del bíceps distal tratados quirúrgicamente por vía anterior limitada. Los 17 últimos casos consecutivos fueron tratados con doble fijación utilizando botón extracortical y tornillo de biotenodesis, y forman parte del estudio. Todos eran hombres, con una mediana de la edad de 41 años (rango 27-59). Los pacientes fueron evaluados con el Cuestionario DASH y el Puntaje Subjetivo/Objetivo de Andrews y Carson, y la fuerza de flexión y supinación se controló con la escala del British Medical Research Council modificada por Mackinnon y Dellon (M0-M5). Resultados: El cuestionario DASH arrojó un valor mediano de 1,7 (0-5,83) y el de Andrews y Carson, de 195 (170-200) para el total; con 15 resultados excelentes y 2 buenos. Todos consiguieron una fuerza M5 para flexión y supinación de antebrazo. El seguimiento tuvo una mediana de 12 meses (4-32). En dos pacientes, se registraron complicaciones, ambas con recuperación ad íntegrum. Conclusión: La técnica descrita ha demostrado ser confiable y eficaz, y permitió lograr resultados satisfactorios y una baja tasa de complicaciones.(AU)

Background: The distal biceps rupture is an unusual lesion produced when an eccentric force is applied to the bent elbow. The aim of this work is to analyze the results for the reinsertion of the distal biceps with a double fixation technique of cortical button and biotenodesis interference screw through a single anterior incision. Methods: Between August 2008 and February 2013 we registered 19 cases of distal biceps rupture, surgically treated through an anterior limited procedure. The last 17 consecutive cases were treated with double fixation using an extracortical button and biotenodesis screw and are part of this study. All the patients were males with a median age of 41 years (range 27-59). The patients were evaluated using the DASH questionnaire and the subjective/ objective scoring system of Andrews and Carson, controlling the flexion and supination forces with the British Medical Research Council scale, modified by Mackinnon and Dellon (M0-M5). Results: DASH questionnaire obtained a median value of 1.7 (0-5.83), and the Andrews and Carson score had a median value of 195 (170-200) for the total; with 15 excellent results and 2 good results. All patients achieved a force of M5 in flexion and supination of the forearm. The follow-up had a median of 12 months (4-32). Complications were registered in two patients, both recovered ad integrum. Conclusion: The described technique proved to be both reliable and effective, giving satisfactory results with a low complication rate.(AU)

Intermediate-term outcomes for floating elbow and floating elbow variant injuries.

BACKGROUND: There are limited outcome studies describing floating elbow injuries. The purpose of this report is to describe patient outcomes after floating elbow injury using the American Shoulder and Elbow Surgeons (ASES) elbow assessment form. MATERIALS AND METHODS: From 1994 to 2004, 19 patients were retrospectively identified at 3 Level I trauma centers and returned for follow-up evaluation after treatment of their floating elbow injury. Patient outcomes were assessed based on physical examination and the ASES elbow form. RESULTS: The 19 patients were evaluated at a mean of 6.7 years (range, 2.3-13.4 years) after treatment of their floating elbow injuries. The mean ASES elbow score was 89 (range, 13-99), and the mean visual analog scale satisfaction with elbow surgery was 8.7 (range, 7-10). Fifteen of 19 patients reported continued pain in the elbow. Patient age, arm dominance, type of humeral fixation, type of forearm fixation, open fracture, multiple surgeries, and fracture pattern were not significantly associated with outcomes. Nerve injury was associated with lower ASES elbow scores (P = .03). There was also a significant correlation between the ASES elbow score and follow-up time, indicating that patients with a longer duration of follow-up had better subjective outcomes (Spearman coefficient = 0.55; P = .02). CONCLUSION: Floating elbow fractures represent high-energy trauma and have significant associated injuries. Nerve injury is correlated with lower subjective outcomes. Patients continue to improve for several years with acceptable mid-term results.