Arthroscopic release of proximal supra-scapular nerve entrapment: Medium-term results. / Liberación artroscópica del atrapamiento proximal del nervio supraescapular: resultados a medio plazo.

OBJECTIVE: To evaluate the clinical and electrophysiological results in the medium term of the arthroscopic release of the proximal entrapment of the suprascapular nerve. MATERIAL AND METHOD: It is a retrospective study that includes 75 patients with idiopathic entrapment of the suprascapular nerve in the suprascapular notch in whom conservative treatment has failed. All patients underwent electrophysiological tests (EMG) as well as clinical test (Constant and DASH test) preoperatively and during follow-up. RESULTS: 75 patients (53 women and 22 men) with a mean age of 44.1 ± 10.7 years met study criteria with a mean follow-up of 63.7 ± 29.1 months. Preoperatively the DASH value was 78,6 ± 10,2, the Constant test value was 37.1 ±8.8 and the EVA value was 8.8 ± 1.1 while the values in the last revision were 19.4 ± 15.8 for DASH, 80.2 ± 9.6 (for the CS and 2 ±1.3 for the EVA scale; the differences were significant in all cases (P<.001). Regarding the results of the electrophysiological test, preoperatively there were 21 very severe grades (28%), 32 severe (42.6%), 17 moderate (22.6%) and 5 mild (6.6%). While in the last review there were 3 severe degrees (4%), 6 moderate (8%), 40 mild (53.3%) and 26 normal (34.6%). There was no very severe grade (0%); 3 patients (4%) had to be reoperated due to persistent symptons. CONCLUSIONS: The arthroscopic release of idiopathic entrapment of the suprascapular nerve in the superior scapular notch achieved good clinical and electrophysiological results in the medium term. LEVEL OF EVIDENCE: iv; case series; treatment study.

Tratamiento de fracturas de tercio distal de clavícula (tipo ii-b de Neer) con sistema de triple botón / Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device

Objetivo. El objetivo de este estudio es describir los resultados de un dispositivo de triple botón para el tratamiento de las fracturas desplazadas de tercio distal de clavícula (tipo ii-b de Neer). Material y método. Estudio retrospectivo de una serie de pacientes entre noviembre de 2011 y diciembre de 2014. Catorce pacientes se ajustaron inicialmente a los criterios de inclusión, 2 de los cuales fueron excluidos, dejando 12 pacientes (83,3% varones; edad media 32,2 años) para el análisis final. El seguimiento medio fue de 26±11,24 meses (rango, 12-48). El seguimiento postoperatorio se realizó a las 2 semanas (en los 2 primeros meses) y después mensualmente, hasta que se consiguió la curación clínica y radiológica. El resultado funcional se evaluó mediante el test de Constant y la puntuación DASH en el último seguimiento. Resultados. La puntuación media del test de Constant fue de 95,5±5,2 puntos (rango, 85-100) y la del test DASH, de 3,3±4,4 puntos (rango: 0-12,5). El tiempo medio para la curación clínica fue de 10,3±3,1 semanas (rango, 8-16) y para la consolidación radiológica, de 13,6±2,6 semanas (rango, 12-20). No hubo complicaciones mayores. Hubo 5 complicaciones menores sin repercusión clínica: 2 calcificaciones coracoclaviculares, una cicatriz hipertrófica, un paciente con molestias sobre el dispositivo y una infección de la herida. Todos los pacientes retomaron su actividad previa. Conclusión. El dispositivo de triple botón consigue excelentes resultados en el tratamiento de las fracturas de tercio distal de clavícula sin necesidad de retirar el material (AU)

Objective. The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). Material and method. A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. Results. The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. Conclusion. Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware (AU)

Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device. / Tratamiento de fracturas de tercio distal de clavícula (tipo ii-b de Neer) con sistema de triple botón.

OBJECTIVE: The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). MATERIAL AND METHOD: A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. RESULTS: The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. CONCLUSION: Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware.

Tratamiento del Hallux valgus moderado con sistema mini TightRope®: técnica modificada / Treatment of moderate Hallux valgus with a mini Tightrope® system: a modified technique

Objetivo. Evaluar los resultados clínicos y radiológicos en el tratamiento del Hallux valgus moderado con el sistema mínimamente invasivo Mini TightRope® (MTR). Material y método. Se han seleccionado 32 pacientes, 36 pies (4 bilaterales), con Hallux valgus en grado moderado según los criterios de Mann y Coughlin, realizando la técnica Mini TightRope® modificada. A dichos pacientes se les ha aplicado la escala de la American Orthopaedic Foot and Ankle Society (AOFAS), la medición del ángulo intermetatarsal (IMA) y del Hallux valgus (AH), posición sesamoideos, movilidad primer dedo del pie, así como el grado de satisfacción obtenido. Resultados. Tras un seguimiento medio de 24 meses se obtuvo una puntuación de 88,0 puntos de media en la escala de AOFAS (47,7 preoperatorio). La corrección radiográfica del IMA y del AH fue de 4,8° y 10,0° de media respectivamente en la última visita. Hemos tenido 6 complicaciones durante el seguimiento (16%), dos de las cuales obligaron a reintervenir al paciente. Discusión y conclusiones. El Mini TightRope® es una técnica reproducible que permite el tratamiento de Hallux valgus moderados. Obtiene la misma corrección que las osteotomías, pero preservando hueso y obviando las complicaciones derivadas de las mismas; así mismo comparte con las técnicas percutáneas su menor agresividad. No obstante, no está exenta de complicaciones, algunas de ellas específicas de esta técnica, que es preciso conocer (AU)

Objective. To evaluate the clinical and radiological results in the treatment of moderate Hallux valgus with a minimally invasive system: Mini Tightrope® (MTR). Material and methods. We selected 32 patients, 36 feet (4 bilateral), with moderate Hallux valgus according to the criteria of Mann and Coughlin, and performed the Mini Tightrope® modified technique. The American Orthopaedic Foot and Ankle Society (AOFAS) scale, the measurement of intermetatarsal angle (IMA) and metatarsophalangeal (MTT-F), sesamoid position, first toe mobility and the level of satisfaction, were assessed in these patients. Results. A mean score of 88.0 points was obtained on the AOFAS scale (47.7 preoperative) after 24 months. In the last visit the radiographic correction of the IMA and the AH was 4.8° and 10.0° on average, respectively. There were 6 complications during follow-up (16%), 2 of which led to the patient being reoperated. Discussion and conclusions. The Mini Tightrope® is a reproducible technique that allows the treatment of moderate Hallux valgus. It achieves the same correction as osteotomies but preserving and avoiding the complications arising from those, being similar to less invasive percutaneous techniques. However, it is not without complications, some of them specific to this technique, which need to be determined (AU)