Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve.

INTRODUCTION: Two types of ganglion cysts at the elbow have been described depending on their anatomic location. Type A ganglion cyst is located proximal to the arcade of Frohse, and type B distal to it. Compressive neuropathies of the radial nerve at the level of the radial tunnel may lead to two different clinical entities with different clinical manifestations. These different conditions depend on which branch is involved. Although compression of the deep motor branch due to a ganglion cyst has been previously described, affection of the superficial sensory branch is considered much rarer. The aim of this study was to describe a series of patients in which painful and dysesthetic symptoms arose from superficial radial nerve compression due to type A ganglion cysts coming from the radiocapitellar joint. METHODS: A review of currently available literature about the disease was carried out. The clinical, histological and radiological records of a series of eight cases (seven patients) with compression of the superficial radial nerve diagnosed and treated between 2008 and 2011 were retrospectively reviewed. All patients complained of pain and dysesthesia at the lateral aspect of the elbow. All patients were initially diagnosed and managed as lateral epicondylitis. Persistence of the symptoms was evidenced in all patients after a course of six months of non-operative management. Magnetic resonance imaging was performed and revealed the presence of a mass compatible with a ganglion cyst coming from the radiocapitellar joint, pushing up the superficial sensory branch of the radial nerve and compressing it against the extensor carpi radialis brevis. Surgical excision was performed in all cases. RESULTS: Histology confirmed the diagnosis of ganglion cysts. Histological findings consisted of dense fibrous tissue, with no synovial or epithelial lining and mucoid material with foamy macrophages. The mean follow-up after surgical excision was 28months (range 24-30). The symptoms subsided in all cases. No complications were registered during the follow-up. CONCLUSION: Type A ganglion cysts of the radiocapitellar joint may involve compression of the superficial radial nerve. Our series of eight cases may suggest that this pathology might not be as rare as it was thought before. This evidence may be useful for the orthopaedic population, who may have another differential diagnosis when managing cases of painful symptoms located in the lateral aspect of the elbow. TYPE OF STUDY: Therapeutic study. LEVEL OF EVIDENCE: IV.

Acute high-grade acromioclavicular joint injuries treatment: Arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF.

INTRODUCTION: Treatment of acute high-grade acromioclavicular joint (ACJ) injuries with metal hardware alters the biomechanics of the ACJ, implying a second surgery for hardware removal. The period during which the plate is present involves functional limitations, pain and a risk factor for the development of hardware-related-injuries. Arthroscopy-assisted procedures compared to open-metal hardware techniques offer: less morbidity, the possibility to treat associated lesions and no need for a second operation. The aim was to compare the Quality of life (QoL) of patients with acute high-grade ACJ injuries (Rockwood grade III-V), managed arthroscopically with a non-rigid coracoclavicular (CC) fixation versus the QoL of patients managed with a hook plate, 24 months or more after their shoulder injury. PATIENTS AND METHODS: A retrospective revision of high-grade ACJ injuries managed in three institutions was performed. Patients treated by means of an arthroscopy-assisted CC fixation or by means of a hook plate were included. The inclusion period was between 2008 and 2012. The QoL was evaluated at the last follow-up visit by means of the SF36, the visual analog scale (VAS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Constant score and the global satisfaction (scale from 0 to 10). The presence of scapular dyskinesis and remaining vertical instability were evaluated. Comparison between groups was performed. RESULTS: Thirty-one patients were included: 20 arthroscopy-group (ARTH group: 3 Rockwood III, 3 IV and 14 V) and 11 hook plate-group (HOOK group: 5 Rockwood III and 6 V). The mean age was 36 [25-52] year-old for the ARTH group and 41 [19-55] for the HOOK group (P=0.185). The mean results of the questionnaires were: (1) physical SF36 score (ARTH group 58.24±2.16 and HOOK group 53.70±4.33, P<0.001); (2) mental SF36 score (ARTH group 56.15±2.21 and HOOK group 53.06±6.10, P=0.049); (3) VAS (ARTH group 0.40±0.50 and HOOK group 1.45±1.51, P=0.007); (4) DASH (ARTH group 2.98±2.03 and HOOK group 4.79±5.60, P=0.200); (5) Constant score (ARTH group 95.30±2.45 and HOOK group 91.36±6.84, P=0.026); (6) global satisfaction (ARTH group 8.85±0.93 and HOOK group 8.00±1.18, P=0.035). There was evidence of scapular dyskinesis in 15% (3/20) of the patients of the ARTH group and in 18% (2/11) of the patients of the HOOK group (P=1.000). Remaining vertical ACJ instability was observed in 40% (8/20) of the patients of the ARTH group and in 36.36% (4/11) of the patients of the HOOK group (P=1.000). CONCLUSION: Patients with acute high-grade ACJ injuries managed arthroscopically with a non-rigid CC fixation seem to have a better QoL than patients managed with a hook plate. LEVEL OF EVIDENCE: Level IV therapeutic; retrospective comparative study.

Tratamiento de la inestabilidad acromioclavicular crónica / Treatment of chronic acromioclavicular joint instability

Valorar los resultados de la técnica quirúrgica asistida por artroscopía indicada para el tratamiento de la inestabilidad acromioclavicular crónica (IAC), basada en la fijación coracoclavicular (CC) no-rígida más reconstrucción CC anatómica con aloinjerto tendinoso. Se incluyó a los pacientes con IAC intervenidos entre 2008 y 2012. Las valoraciones clínicas se realizaron mediante el SF36, la EVA y el DASH, aplicados en la visita previa (VPI) a la intervención y en la última visita de seguimiento (UVS). El Constant score y la Escala de Satisfacción General (0-10) se aplicaron en la última visita de seguimiento. Se valoró el desarrollo de subluxaciones secundarias. Se incluyeron 10 pacientes. Edad media 41 años [rango 33-55]. Seguimiento medio 25.50 meses [rango 24-30].En todos los pacientes el tratamiento quirúrgico se indicó cuando el tratamiento conservador fracasó. Cuestionarios aplicados en la VPI y en la UVS: 1. SF36 físico: VPI 29.60 ± 3.41 y UVS 59.58 ± 1.98 (p = 0.000); 2. SF36 mental: VPI 46.57 ± 3.80 y UVS 56.62 ± 1.89 (p = 0.000); 3. EVA: VPI 5.17 ± 2.40 y UVS 1.67 ± 2.07 (p = 0.022); y 4. DASH: VPI 63.33 ± 23.56 y UVS 2.61 ± 1.79 (p = 0.000). El Constant score y la satisfacción general de la UVS fueron 95.56 ± 3.28 y 9.22 ± 0.67 respectivamente. No hubo subluxaciones secundarias. El tratamiento de la IAC mediante un dispositivo de suspensión CC y una reconstrucción anatómica de los ligamentos CC asistida por artroscopía, puede ofrecer una mejoría significativa de la calidad de vida de los pacientes y representa una estrategia que al contemplar una fijación CC mecánica primaria, puede minimizar las posibilidades de fracaso y desarrollo de subluxaciones secundarias.

The purpose of this paper is to assess the results obtained with the arthroscopy-assisted surgical technique for the treatment of chronic acromioclavicular joint instability (CACJI), based on non-rigid coracoclavicular (CC) fixation and anatomical CC reconstruction with a tendinous allograft. Patients with CACJI who underwent surgery between 2008 and 2012 were included in the study. Clinical assessments included SF36, VAS and DASH, applied at the preoperative visit (POV) and at the last follow-up visit (LFUV). The Constant score and the General Satisfaction Score (0-10) were applied at the last follow-up visit. Occurrence of secondary subluxations was assessed. Ten patients were included; mean age was 41 years (range 33-55). Mean follow-up was 25.50 months (range 24-30). Surgical treatment was indicated in all patients after failure of conservative treatment. Questionnaires applied at the POV and the LFUV showed the following results: 1. SF36: physical, POV = 29.60 ± 3.41 and LFUV = 59.58 ± 1.98 (p = 0.000); 2. SF36 mental, POV = 46.57 ± 3.80 and LFUV = 56.62 ± 1.89 (p = 0.000); 3. VAS: POV = 5.17 ± 2.40 and LFUV: 1.67 ± 2.07 (p = 0.022); and 4. DASH: POV = 63.33 ± 23.56 and LFUV = 2.61 ± 1.79 (p = 0.000). The Constant score and the general satisfaction at the LFUV were 95.56 ± 3.28 and 9.22 ± 0.67, respectively. There were no secondary subluxations. Treatment of CACJI with a CC suspension device and arthroscopically-assisted anatomical reconstruction of CC ligaments may provide a significant quality of life improvement to patients. It is a strategy that, upon considering primary mechanical CC fixation, may minimize the chance of failure and occurrence of secondary subluxations.

[Treatment of chronic acromioclavicular joint instability]. / Tratamiento de la inestabilidad acromioclavicular crónica.

The purpose of this paper is to assess the results obtained with the arthroscopy-assisted surgical technique for the treatment of chronic acromioclavicular joint instability (CACJI), based on non-rigid coracoclavicular (CC) fixation and anatomical CC reconstruction with a tendinous allograft. Patients with CACJI who underwent surgery between 2008 and 2012 were included in the study. Clinical assessments included SF36, VAS and DASH, applied at the preoperative visit (POV) and at the last follow-up visit (LFUV). The Constant score and the General Satisfaction Score (0-10) were applied at the last follow-up visit. Occurrence of secondary subluxations was assessed. Ten patients were included; mean age was 41 years (range 33-55). Mean follow-up was 25.50 months (range 24-30). Surgical treatment was indicated in all patients after failure of conservative treatment. Questionnaires applied at the POV and the LFUV showed the following results: 1. SF36: physical, POV = 29.60 ± 3.41 and LFUV = 59.58 ± 1.98 (p = 0.000); 2. SF36 mental, POV = 46.57 ± 3.80 and LFUV = 56.62 ± 1.89 (p = 0.000); 3. VAS: POV = 5.17 ± 2.40 and LFUV: 1.67 ± 2.07 (p = 0.022); and 4. DASH: POV = 63.33 ± 23.56 and LFUV = 2.61 ± 1.79 (p = 0.000). The Constant score and the general satisfaction at the LFUV were 95.56 ± 3.28 and 9.22 ± 0.67, respectively. There were no secondary subluxations. Treatment of CACJI with a CC suspension device and arthroscopically-assisted anatomical reconstruction of CC ligaments may provide a significant quality of life improvement to patients. It is a strategy that, upon considering primary mechanical CC fixation, may minimize the chance of failure and occurrence of secondary subluxations.

Luxación palmar de la articulación metacarpofalángica del pulgar / Palmar dislocation of the metacarpophalangeal joint of the thumb

Presentamos el caso de un hombre de 41 años con una luxación palmar de la articulación metacarpofalángica del pulgar sin semiología de interposición de partes blandas, en el que se realizó reducción cerrada. El resultado fue satisfactorio. Se evidenció bostezo del ligamento colateral radial (AU)

Open reduction is considered almost mandatory, because soft tissue interposition is usually the norm. Soft tissue interposition can be inferred with the physical examination. Methods: We present the case of a 41 year old man with a palmar dislocation of the metacarpophalangeal joint of the thumb in which we achieved a satisfactory closed reduction. Closed reduction was successful. Instability of the radial collateral ligament was identified (AU)

Ácido tranexámico en cirugía ortopédica / Tranexamic acid in orthopedic surgery

El sangrado perioperatorio en ocasiones conduce a transfusiones sanguíneas no exentas de complicaciones y riesgos, con un alto gasto sanitario. Entre otros métodos de prevención, el tratamiento con ácido tranexámico (TXA) ha mostrado ser efectivo en la disminución de las pérdidas sanguíneas quirúrgicas y especialmente en el postoperatorio inmediato. Al respecto, los estudios que lo han evaluado en cirugía ortopédica muestran su eficacia y seguridad, administrado por vía tanto intravenosa como intraarticular. Las dosis habituales por vía intravenosa evaluadas oscilan entre 10 y 20 mg/kg, o en dosis fijas de 1 a 2 g, mientras por vía intraarticular varía entre 250 mg y 3 g. El TXA como antifibrinolítico tiene un potencial efecto trombótico y está contraindicado en aquellos pacientes con riesgo o antecedentes de trombosis. Su administración por vía tópica podría ser más segura aunque se precisan estudios que lo confirmen (AU)

Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10 mg/Kg and 20 mg/kg or a fixed dose of 1 g to 2 g; while intra-articularly, it varies between 250 mg and 3 g. ATX, as an anti-fibrinolytic has a potential thrombotic effect, thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this (AU)

[Tranexamic acid in orthopedic surgery]. / Ácido tranexámico en cirugía ortopédica.

Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10mg/Kg and 20mg/kg or a fixed dose of 1g to 2g; while intra-articularly, it varies between 250 mg and 3g. ATX, as an anti-fibrinolytic has a potential thrombotic effect, thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this.

Síndrome de Fenton / Fenton syndrome

El síndrome de la fractura-luxación transescafo-hueso grande o síndrome de Fenton, constituye una lesión muy poco frecuente. En este artículo se presentan 3 casos que fueron tratados mediante reducción abierta y fijación interna con minitornillos, obteniendo buenos resultados a los 16 meses del seguimiento medio (AU)

Scaphocapitate, or Fenton syndrome, is a rare injury. This article presents three new cases that were treated by open reduction and internal fixation with miniscrews, obtaining good results at 16 months follow-up (AU)

[Fenton syndrome]. / Síndrome de Fenton.

Scaphocapitate, or Fenton syndrome, is a rare injury. This article presents three new cases that were treated by open reduction and internal fixation with miniscrews, obtaining good results at 16 months follow-up.