Artroplastia de silicona del semilunar en la enfermedad de Kienböck: seguimiento a largo plazo / Lunate bone silicone arthroplasty in Kienböck's disease: long-term follow-up

Entre 1986 y 1993 se trataron 20 pacientes con implantes de silicona para la enfermedad de Kienböck con un seguimiento medio de 7 años. La edad media de los pacientes era de 33 años y según la clasificación de Lichtman ocho fueron Grado II, ocho Grado IIIA y cuatro Grado IIIB. Al final del seguimiento el 75 por ciento presentaban persistencia del dolor y un balance articular limitado. A nivel radiológico hubo un colapso carpiano (altura carpiana media de 0,49) y una traslación cubital (distancia cubitocarpiana media de 0,26).Se presentaron las siguientes complicaciones: luxación del implante hacia cubital en dos pacientes; subluxación en dos, una palmar y otra dorsal; presencia de inestabilidad en DISI en seis y en VISI en dos; siliconitis e imágenes líticas intraóseas en ocho y presencia de artropatía degenerativa radio e intercarpiana en 10.Cuatro pacientes precisaron de reintervención: tres artrodesis del carpo y una resección de la primera fila. El implante de silicona genera a largo plazo una sinovitis reactiva con destrucción del carpo, siendo incapaz de frenar la evolución a colapso carpiano y a traslación cubital. A causa de sus limitaciones no creemos que tenga indicación actualmente en el tratamiento de la enfermedad de Kienböck (AU)

Conservative treatment of displaced fractures of the olecranon in the elderly.

We have analysed the functional results of the conservative treatment of displaced olecranon fractures in 12 patients with a mean age of 81.8 (73-90) years. The patients were evaluated at the time of the final follow up which was 15.2 (6-33) months. Physical examination and radiographic study were performed. None of the patients were limited in their daily activities. 67% of the patients were asymptomatic with an acceptable range of motion of their elbows. The clinical results were good in 8 cases, fair in 3 and poor in one, in spite of 9 cases of pseudoarthrosis. The grade of satisfaction was excellent in 11 patients and bad in only one. Conservative treatment of displaced olecranon fractures provides satisfactory results in old patients.

Trapezius transfer for shoulder paralysis. 6 patients with brachial plexus injuries followed for 1 year.

We transferred the trapezius with its bone insertion to the proximal humerus in 6 patients for treatment of a paralytic shoulder secondary to traumatic lesions of the brachial plexus. After 1 year, the shoulder abduction was improved from average 13 degrees (0 degrees-30 degrees) preoperatively to 76 degrees (50 degrees-100 degrees) postoperatively, and the shoulder flexion from 18 degrees (0 degrees-40 degrees) to 78 degrees (45 degrees-110 degrees) postoperatively. All the patients were satisfied with the outcome. We consider that transfer of the trapezius in a paralytic shoulder after brachial plexus injury gives a better outcome than shoulder fusion.

[Simultaneous luxation of proximal and distal interphalangeal joints of the fingers]. / Luxation simultanée des articulations interphalangiennes, proximale et distale, des doigts de la main.

We report five cases of simultaneous dislocation of both interphalangeal joints of the finger. We observed that the mechanism, diagnosis and treatment of our cases were similar to the published reports of the world literature. In conclusion, we remark that this injury, of rare occurrence, should be treated with conservative treatment by manipulation, and if a good functional result is desired, adequate physiotherapy treatment is required.