Luxación traumática de la articulación trapeciometacarpiana / Traumatic dislocation of the trapeziometacarpal joint

Objetivo: Evaluar los resultados obtenidos al tratar de forma conservadora (mediante reducción cerrada seguida de inmovilización con un yeso antebraquial de escafoides) las luxaciones agudas de la articulación trapeciometacarpiana (ATM). Material y método: Se trató a 7 sujetos (4 varones y 3 mujeres) afectados de luxación aguda traumática de la ATM. Material y método: A todos los sujetos se les realizó reducción cerrada e inmovilización con un yeso antebraquial tipo escafoides por un período de 6 semanas. En 2 casos fue necesario estabilización adicional mediante agujas de Kirschner. El período de seguimiento ha sido de 36 a 79 meses. Resultados: Los resultados fueron satisfactorios en todos los sujetos, ninguno presentaba sintomatología o subluxación residual en los estudios radiográficos en el último control. Todos los sujetos retornaron a su actividad previa al accidente. Discusión: Las luxaciones trapeciometacarpianas son lesiones infrecuentes. La reducción cerrada seguida de inmovilización (combinada con agujas de Kirschner en aquellos casos de inestabilidad residual tras la reducción) ofrece resultados satisfactorios (AU)

Purpose: To assess the results of the use of conservative treatment, consisting of closed reduction followed by scaphoid-type forearm cast immobilization, to treta acute dislocations of the trapeziometacarpal joint. Materials and methods: Seven patients were treated, 4 males and 3 females, who had suffered an acute traumatic dislocation of the trapeziometacarpal joint. Materials and methods: All patients were subjected to closed reduction followed by immobilization with a scaphoid-type forearm cast for a period of 6 weeks. In 2 cases additional stabilization was required by means of K-wires. Mean follow-up was 36–79 months. Results: Results were satisfactory in all patients. At the last follow-up visit none of them presented with symptoms, nor any residual dislocations were observed radiographically. All patients went back to their pre-accident activities. DiscussionTrapeziometacarpal dislocations are an unusual occurrence. Closed reduction followed by immobilization (combined with K-wires in cases of residual instability further to reduction) offers satisfactory results (AU)

Traumatic lumbosacral dislocation.

STUDY DESIGN: Case report of a patient with lumbosacral dislocation. OBJECTIVES: To report a case of traumatic lumbosacral dislocation treated nonoperatively, with 10 years of follow-up. SUMMARY OF BACKGROUND DATA: Lumbosacral dislocation is rare, with only 48 cases reported in the literature. Surgical treatment by means of open reduction and fusion is advisable. However, the literature shows six cases of patients with complete lumbosacral dislocation treated nonoperatively with good results. METHODS: A 38-year-old man was involved in a highspeed vehicle accident. The lumbosacral dislocation (anterior displacement of L5 on S1, 44% slippage) was initially missed, and the patient was treated conservatively. RESULTS: Slippage did not progress, and the patient returned to full, normal activity. Ten years later he is asymptomatic and is able to work and play sports. CONCLUSIONS: This study reports a rare injury of the lumbosacral junction that was detected 3 months after injury. Satisfactory results were obtained with nonoperative treatment in this case. Although a surgical approach is advisable in acute cases to decompress the neurologic structures and to stabilize the lumbosacral junction, conservative management may be the treatment of choice in inveterate lesions.

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.