Liberación endoscópica del nervio mediano en el tercio proximal del antebrazo. Nuevo abordaje / Endoscopic release of the median nerve in the proximal third of the forearm. A new approach

Introducción: El síndrome de pronador ha requerido clásicamente una cirugía abierta que deja gran cicatriz; técnicas endoscópicas iniciales requerían abordajes de 4cm en promedio y sin lograr una liberación de todas las estructuras. El propósito de este estudio es describir un nuevo abordaje endoscópico que permita descomprimir el nervio mediano de forma segura y completa con una cicatriz de menor tamaño y menos visible. Métodos: Descripción de una nueva técnica de descompresión del nervio mediano en el tercio proximal del antebrazo con incisión mínima y técnica endoscópica en especímenes cadavéricos criopreservados, describiendo incisión, anatomía endoscópica, corredores seguros y sitios de descompresión. Resultados: Se realizó en 20 codos de cadáveres abordaje endoscópico del nervio mediano en el antebrazo proximal con endoscopio de 4mm y 0° de angulación. Se presentan ventajas y limitaciones de la técnica y detalles quirúrgicos para la liberación en los puntos de compresión más comunes del nervio en el antebrazo. Realizamos en 3 pacientes esta técnica con buenos resultados y sin complicaciones. Discusión: Es posible la liberación del nervio mediano y la sección de estructuras aponeuróticas potenciales de compresión por endoscopia. La cabeza cubital del pronador y la arcada aponeurótica del flexor digitorum superficialis están implicados frecuentemente en el síndrome. La cicatriz es estéticamente buena. Es una técnica relativamente nueva, con menor morbilidad, que permite una recuperación más rápida de los pacientes. Conclusiones: Es posible realizar una descompresión completa del nervio mediano en el antebrazo con técnica endoscópica, segura y menor comorbilidad para el paciente

Introduction: Pronator syndrome has classically required open surgery that leaves a large scar; initial endoscopic techniques required approaches of an average 4cm without achieving release of all structures. The purpose of this study was to describe a new endoscopic approach that allows the median nerve to be safely and completely decompressed, leaving a smaller and less visible scar. Methods: Description of a new approach for decompression of the median nerve in the proximal third of the forearm with minimal incision and endoscopic technique in cryopreserved cadaveric specimens, describing incision, endoscopic anatomy, safe corridors and decompression sites. Results: In 20 elbows of cadavers, an endoscopic approach of the median nerve in the proximal forearm with a 4mm endoscope and 0° of angulation was performed. The advantages and limitations of the technique and surgical details are presented for release in the most common compression points of the nerve in the forearm. We performed this technique in 3 patients with good results without complications. Discussion: Release of the median nerve and section of potential aponeurotic compression structures by endoscopy is possible. The ulnar head of the pronator and the aponeurotic arch of the flexor digitorum superficialis are frequently implicated in the syndrome. The scar is aesthetically good. It is a relatively new technique, with lower morbidity that allows faster recovery of patients. Conclusions: It is possible to perform a complete decompression of the median nerve in the forearm using an endoscopic approach, safely with lower comorbidity for the patient

Endoscopic release of the median nerve in the proximal third of the forearm. A new approach. / Liberación endoscópica del nervio mediano en el tercio proximal del antebrazo. Nuevo abordaje.

INTRODUCTION: Pronator syndrome has classically required open surgery that leaves a large scar; initial endoscopic techniques required approaches of an average 4cm without achieving release of all structures. The purpose of this study was to describe a new endoscopic approach that allows the median nerve to be safely and completely decompressed, leaving a smaller and less visible scar. METHODS: Description of a new approach for decompression of the median nerve in the proximal third of the forearm with minimal incision and endoscopic technique in cryopreserved cadaveric specimens, describing incision, endoscopic anatomy, safe corridors and decompression sites. RESULTS: In 20 elbows of cadavers, an endoscopic approach of the median nerve in the proximal forearm with a 4mm endoscope and 0° of angulation was performed. The advantages and limitations of the technique and surgical details are presented for release in the most common compression points of the nerve in the forearm. We performed this technique in 3 patients with good results without complications. DISCUSSION: Release of the median nerve and section of potential aponeurotic compression structures by endoscopy is possible. The ulnar head of the pronator and the aponeurotic arch of the flexor digitorum superficialis are frequently implicated in the syndrome. The scar is aesthetically good. It is a relatively new technique, with lower morbidity that allows faster recovery of patients. CONCLUSIONS: It is possible to perform a complete decompression of the median nerve in the forearm using an endoscopic approach, safely with lower comorbidity for the patient.

Deficiencia radial longitudinal. Análisis de resultados clínicos y radiológicos / Radial longitudinal deficiency. Analysis of clinical and radiological results

Introducción: La deficiencia radial longitudinal comprende anormalidades óseas, musculotendinosas y neurovasculares de etiología multifactorial del lado radial de la extremidad superior. El tratamiento incluye mejorar la longitud, la apariencia y el funcionamiento de la mano. El objetivo del trabajo es mostrar la experiencia en una serie de pacientes atendidos en los últimos 15 años y describir resultados clínicos y radiológicos. Metodología: Estudio retrospectivo de pacientes con deficiencia radial longitudinal entre 2000 a 2016. Se analizaron variables y se identificaron asociaciones de edad al momento de cirugía, sexo, lateralidad, grado de la deformidad según la clasificación Bayne-Klug modificada, técnica quirúrgica realizada, daño de la fisis, enfermedades asociadas, resultados funcionales y radiológicos. Resultados: Cuarenta y siete casos de 65 cumplían con criterios de inclusión. La edad promedio de la cirugía fue de 19 meses, 61% de sexo femenino. Según la clasificación el tipo IV fue el 60%, el tipo III el 19%, el tipo 0 el 17% y tipo I el 4%. La intervención practicada fue la centralización en el 72,3%, la radialización en el 8,5% y hubo un caso de alargamiento. Se realizó osteotomía de cúbito en el 55,3%. Hubo daño de la fisis en el 31%. La posición radiológica postoperatoria fue neutra en el 48,9%. Conclusiones: En pacientes con centralización a un año se observa una buena corrección clínica y radiológica, sin embargo esta se va perdiendo con el tiempo. El tratamiento de los tejidos blandos previo a la centralización se cree que permite obtener mejores resultados. El uso de clavo intramedular del cúbito al carpo podría estar asociado con daño de fisis del cúbito distal

Introduction: radial longitudinal deficiency (RLD) includes bone, musculotendinous and neurovascular abnormalities of multifactorial aetiology of the radial side of the upper extremity. Treatment includes improving the length of the limb, the appearance and functioning of the hand. The aim of this study was to present our experience in a series of patients attended over the past 15 years and to describe the clinical and radiological results. Methodology: a retrospective study of patients with RLD between 2000 and 2016. Variables were analyzed and age associations were identified at the time of surgery, sex, laterality, type of deformity according to the modified Bayne-Klug classification, surgical technique, physis damage, associated diseases, functional and radiological results. Results: 47 cases of 65 met the inclusion criteria. The average age of surgery was 19 months, 61% female. According to classification 60% were type IV, type III 19%, type 0 in 17% and type I in 4%. The intervention was centralization 72.3%, radialization 8.5% and one case of lengthening. Ulna osteotomy was performed in 55.3%. There was damage to the physis in 31%. The postoperative radiological position was neutral in 48.9%. Conclusions: In patients with centralization at 1year, good clinical and radiological correction were observed, however this was lost over time. The management of soft tissues prior to centralization is believed to give better results. The use of intramedullary nail from the ulna to the carpus could be associated with damage to the distal ulna

Radial longitudinal deficiency. Analysis of clinical and radiological results. / Deficiencia radial longitudinal. Análisis de resultados clínicos y radiológicos.

INTRODUCTION: radial longitudinal deficiency (RLD) includes bone, musculotendinous and neurovascular abnormalities of multifactorial aetiology of the radial side of the upper extremity. Treatment includes improving the length of the limb, the appearance and functioning of the hand. The aim of this study was to present our experience in a series of patients attended over the past 15 years and to describe the clinical and radiological results. METHODOLOGY: a retrospective study of patients with RLD between 2000 and 2016. Variables were analyzed and age associations were identified at the time of surgery, sex, laterality, type of deformity according to the modified Bayne-Klug classification, surgical technique, physis damage, associated diseases, functional and radiological results. RESULTS: 47 cases of 65 met the inclusion criteria. The average age of surgery was 19 months, 61% female. According to classification 60% were type IV, type III 19%, type 0 in 17% and type I in 4%. The intervention was centralization 72.3%, radialization 8.5% and one case of lengthening. Ulna osteotomy was performed in 55.3%. There was damage to the physis in 31%. The postoperative radiological position was neutral in 48.9%. CONCLUSIONS: In patients with centralization at 1year, good clinical and radiological correction were observed, however this was lost over time. The management of soft tissues prior to centralization is believed to give better results. The use of intramedullary nail from the ulna to the carpus could be associated with damage to the distal ulna.

Valores normales de 3 métodos para determinar rótula alta en niños de 6 a 12 años / Normal values of 3 methods to determine patellar height in children from 6 to 12 years

El objetivo del estudio es comparar 3 métodos para medición de rótula alta en niños, Caton-Deschamps, Blackburne-Peel y Koshino-Sugimoto, y determinar cuál es el valor normal de cada método en un grupo de niños normales. Materiales y métodos: Es un estudio de corte transversal en radiografías de rodillas de niños normales. Tres cirujanos ortopédicos midieron los índices de Caton-Deschamps, Blackburne-Peel y Koshino-Sugimoto. Se realizó la evaluación de la concordancia mediante el coeficiente de correlación intraclase. Para la variabilidad interobservador, se compararon las mediciones de cada observador para cada índice y para la variabilidad intraobservador se calculó el coeficiente entre las 2 mediciones por un mismo observador en 2 momentos diferentes. Resultados: Se obtuvieron 140 radiografías de rodilla divididas en 4 grupos etarios. Para el índice de Blackburne-Peel se obtuvo una mediana en promedio de los 3 observadores de 1,07 y con P5-P95 (0,76-1,60). Para el índice de Caton-Deschamps se obtuvo una mediana en promedio de los 3 observadores de 1,22 y con P5-P95 (0,91-1,70). Para el índice de Koshino-Sugimoto se obtuvo una mediana en promedio de los 3 observadores de 1,16 y con P5-P95 (0,99-1,36). Discusión: Este estudio muestra que el índice de Koshino-Sugimoto fue el de mayor fiabilidad, reproducibilidad y similitud en la población estudiada tanto intraobservador como interobservador. Los otros métodos evaluados también presentan unos índices de variabilidad a tener en consideración pero inferiores al de Koshino-Sugimoto

The aim of the study was to compare three methods for high-score measurement in children, Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto, to determine the normal value of each method in a group of normal children. Materials and methods: A cross-sectional study on knee x-rays of normal children. Three orthopaedic surgeons measured the Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto indices. Concordance was assessed using the intraclass correlation coefficient. For interobserver variability, the measurements of each observer for each index were compared and for intraobserver variability, the coefficient between the 2 measurements was calculated by the same observer at 2 different times. Results: 140 knee X-rays divided into 4 age groups were obtained. For the Blackburne-Peel index, an average median of the 3 observers was obtained of 1.07 and with P5-P95 (0.76-1.60). For the Caton-Deschamps index, an average median of the three observers of 1.22 was obtained and with P5-P95 (0.91-1.70). For the Koshino-Sugimoto index, we obtained an average median of the 3 observers of 1.16 and with P5-P95 (0.99-1.36). Discussion: This study shows that the Koshino-Sugimoto index had the highest reliability, reproducibility and similarity in the population studied, both intra-observer and inter-observer. The other methods evaluated also had variability indices to be taken into account, but were inferior to the Koshino-Sugimoto index

Normal values of 3 methods to determine patellar height in children from 6 to 12 years. / Valores normales de 3 métodos para determinar rótula alta en niños de 6 a 12 años.

The aim of the study was to compare three methods for high-score measurement in children, Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto, to determine the normal value of each method in a group of normal children. MATERIALS AND METHODS: A cross-sectional study on knee x-rays of normal children. Three orthopaedic surgeons measured the Caton-Deschamps, Blackburne-Peel and Koshino-Sugimoto indices. Concordance was assessed using the intraclass correlation coefficient. For interobserver variability, the measurements of each observer for each index were compared and for intraobserver variability, the coefficient between the 2 measurements was calculated by the same observer at 2 different times. RESULTS: 140 knee X-rays divided into 4 age groups were obtained. For the Blackburne-Peel index, an average median of the 3 observers was obtained of 1.07 and with P5-P95 (0.76-1.60). For the Caton-Deschamps index, an average median of the three observers of 1.22 was obtained and with P5-P95 (0.91-1.70). For the Koshino-Sugimoto index, we obtained an average median of the 3 observers of 1.16 and with P5-P95 (0.99-1.36). DISCUSSION: This study shows that the Koshino-Sugimoto index had the highest reliability, reproducibility and similarity in the population studied, both intra-observer and inter-observer. The other methods evaluated also had variability indices to be taken into account, but were inferior to the Koshino-Sugimoto index.

Fracturas diafisarias del antebrazo en niños: tratamiento con fijación intramedular con clavos de Kirschner / Forearm diaphyseal fractures in children: intramedullary Kirschner's wire fixation treatment

Introducción. Las fracturas diafisarias del antebrazo constituyen el 6-10% de todas las fracturas en niños. El tratamiento depende de la edad y el tipo de desplazamiento y son válidos el manejo conservador y quirúrgico con fijación de clavos intramedulares entre otros. El objetivo es mostrar los resultados radiológicos y funcionales, y las complicaciones de la fijación intramedular con clavos de Kirschner en niños. Materiales y métodos. Es una serie de casos retrospectiva descriptiva de pacientes operados con fijación intramedular de fracturas de antebrazo. Se correlacionan los resultados radiológicos y funcionales y las complicaciones. Resultados. De 117 pacientes operados, 59 cumplían criterios de inclusión. La edad promedio fue 10 años. El 84,7% de ellos fueron hombres y el izquierdo el lado más afectado (62,7%). El 88,1% de ambos huesos estaban fracturados y 11 casos tenían fracturas abiertas. Se realizó reducción abierta en el 72,8% de los casos cuyas principales indicaciones fueron inestabilidad, reducción fallida y refractura. Se tuvieron 52 resultados excelentes, 2 buenos, 4 regulares y uno malo. Hubo un 13,5% de complicaciones menores. Discusión. Este estudio muestra que la fijación intramedular con clavos de Kirschner en fracturas de diáfisis de radio y cúbito de niños es un procedimiento seguro, de bajo costo y que ofrece a corto y mediano plazo adecuados resultados funcionales, con una prevalencia baja de complicaciones graves, con solo 6 casos de no consolidación y refracturas. Las angulaciones preoperatorias mayores en los planos anteroposterior y lateral, y angulaciones posoperatorias en el plano lateral, podrían considerarse predictores de resultados funcionales menos satisfactorios (AU)

Introduction. Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. Materials and methods. A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. Results. Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. Discussion. This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results (AU)

Forearm diaphyseal fractures in children: intramedullary Kirschner's wire fixation treatment. / Fracturas diafisarias del antebrazo en niños: tratamiento con fijación intramedular con clavos de Kirschner.

INTRODUCTION: Diaphyseal fractures of the forearm comprise 6%-10% of all fractures in children. The treatment depends on the age and type of displacement, and conservative and surgical management with fixation of intramedullary nails, among other techniques, is valid. The aim is to show the radiological and functional outcomes, and complications of intramedullary fixation with Kirschner nails in children. MATERIALS AND METHODS: A retrospective descriptive case series of patients treated with intramedullary fixation of forearm fractures. The radiological and functional results, and complications are correlated. RESULTS: Of the 117 patients operated, 59 met the inclusion criteria. The average age was 10 years. Eighty-four point seven percent were males and the left side was the most affected (62.7%). In 88.1% both bones were fractured and 11 cases had open fractures. An open reduction was performed in 72.8% of the cases, the main indications for this being instability, failed reduction and refracture. There were 52 excellent outcomes, 2 good, and 4 regular and 1 bad. There were 13.5% minor complications. DISCUSSION: This study shows that intramedullary fixation with Kirschner nails in radius and ulna diaphysis fractures in children is a safe, low-cost procedure and offers adequate short and medium term functional outcomes, with a low prevalence of serious complications with only 6 cases of non-consolidation and refracture. Larger preoperative angulations in the anteroposterior and lateral planes, and lateral postoperative angulations, could be considered predictors of less satisfactory functional results.

Transferencia de la cabeza larga del tríceps para la flexión del codo en secuela de lesiones del plexo braquial / Transfer of the long head of triceps for elbow flexion in braquial plexus sequelae

Resumen: La anatomía neurovascular independiente de la cabeza larga del tríceps braquial y su idoneidad como un colgajo muscular libre han sido ampliamente estudiadas. En cambio, la trasposición de esta porción del tríceps para mejorar la flexión de codo ha sido descrita pocas veces. Se describen en este artículo dos casos de secuela de lesión del plexo braquial, en los que se realizó trasposición únicamente de la cabeza larga del tríceps. Se logró mejorar la flexión del codo y se conservó la extensión del mismo.

Abstract: The independent neurovascular anatomy of the long head of the triceps brachii and its suitability as a free muscle transfer have been extensively studied. Instead muscle transposition of the long head of the triceps brachii to enhance elbow flexion has been rarely described. We describe in this paper two cases of injury of brachial plexus sequel in which transposition was performed only on the long head of the triceps. The elbow flexion was improved, the extension was preserved.

Evaluación radiológica de muñeca para visualizar la superficie articular del radio / Wrist X ray for analysis of the articular surface of distal radius

Resumen: En la fractura del radio distal se requieren proyecciones radiológicas que permitan ver adecuadamente la superficie articular sin interposición de estructuras. El objetivo fue determinar si las proyecciones radiológicas laterales a 7 y 22o mejoran el análisis de esta superficie. Método: Serie de casos con radiografías de pacientes sanos y operados para identificar las facetas del semilunar y escafoides en las proyecciones lateral y anteroposterior, igualmente se evaluó con tornillos. Se analizaron cualitativamente los hallazgos obtenidos en las radiografías de 7 y 22o para la proyección lateral y de 11o en la anteroposterior. Resultados: 14 radiografías de voluntarios sanos, 10 pacientes con fractura de radio que recibieron osteosíntesis y dos piezas anatómicas. En los 14 sanos y los 10 pacientes se encontró que en las proyecciones a 7 y 22o pueden apreciarse mejor las carillas radio-semilunar y radio-escafoides respectivamente, observando imágenes con menor superposición de estructuras en la radiografía de 22o tanto en los sanos como en los pacientes con fracturas. Discusión: Las proyecciones radiológicas son importantes para poder determinar los resultados inmediatos de una osteosíntesis realizada en una fractura de radio distal. En este estudio se observa que la proyección lateral a 7o identifica mejor la posición de los tornillos ubicados en la carilla semilunar del radio. La proyección lateral a 22o muestra mejor la carilla con el escafoides. Por último en la proyección anteroposterior a 11o nos permite ver la articulación radiocarpiana con menor superposición de imágenes.

Abstract: In the distal radius fracture requires radiographic views that allow you to see the articular surface without interposition. The objective was to determine whether lateral radiographic projections 7 and 22o improve the analysis of this surface. Method: Case series study with radiographs of healthy and operated patients, in order to identify the lunate and scaphoid facets in lateral and anteroposterior projections. Qualitative analysis was made on the radiographs of the distal radius with wedges of 7 and 22o in the lateral views and 11o in the anteroposterior view. Results: There were evaluated 14 radiographs of the distal radius of healthy volunteers and 10 patients with distal radius fractures who recieved surgery with internal fixation, and also two anatomical models. In 14 healthy and 10 patients, it was found that the views at 7 and 22o can be better appreciated radio lunate and radio scaphoid surface respectively, observing images with less overlapping in the radiograph of 22o in both groups. Discussion: Radiographic views are important to determine the immediate results of fixation on a distal radius fracture. We observe that the lateral view at 7o is better to show the screws on the lunate facet of the radius. The lateral view at 22o is better to show the facet of the radius with the scaphoid. Finally, the anteroposterior projection at 11o allows us to see the radio carpal joint with lower image overlay.

Características radiológicas del desarrollo de la tuberosidad tibial anterior / Radiographic features of the development of the anterior tibial tuberosity

Objetivo. Existen pocos estudios que evalúen las características radiológicas del desarrollo de la tuberosidad tibial anterior (TTA). El presente trabajo tiene por objeto evaluar las características radiológicas de la TTA en una población pediátrica de acuerdo a grupos de edad. Material y métodos. Es un estudio llevado a cabo en 210 radiografías de rodillas de pacientes entre los 10 y 17 años, que fueron divididos por grupos de edad y sexo. Se evaluaron la presencia de osificación de la TTA, la distancia de esta a la metáfisis y la fusión con la epífisis. Resultados. A los 10 años de edad, la TTA estaba osificada en el 50% de las mujeres y solo en el 25% de los hombres. A los 11 años todas las mujeres tenían osificada la TTA, a los 12 tenían fusión de la TTA y con la epífisis, y a los 17 años la fusión era completa. En los hombres este proceso se produce un año más tarde que en las mujeres. En todos los casos se encontró un solo núcleo de osificación. Conclusión. La osificación de la TTA se inicia distalmente, posteriormente se fusiona su parte proximal con el resto de la epífisis y finalmente se fusiona en su parte distal a la tibia. Este estudio ayuda a un mejor análisis de la TTA cuando nos enfrentamos a un dolor de rodilla (AU)

Objective. Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups. Material and methods. We assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis. Results. At 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases. Conclusion. The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain (AU)

Radiographic features of the development of the anterior tibial tuberosity. / Características radiológicas del desarrollo de la tuberosidad tibial anterior.

OBJECTIVE: Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups. MATERIAL AND METHODS: We assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis. RESULTS: At 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases. CONCLUSION: The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain.

[Transfer of the long head of triceps for elbow flexion in braquial plexus sequelae]. / Transferencia de la cabeza larga del tríceps para la flexión del codo en secuela de lesiones del plexo braquial.

The independent neurovascular anatomy of the long head of the triceps brachii and its suitability as a free muscle transfer have been extensively studied. Instead muscle transposition of the long head of the triceps brachii to enhance elbow flexion has been rarely described. We describe in this paper two cases of injury of brachial plexus sequel in which transposition was performed only on the long head of the triceps. The elbow flexion was improved, the extension was preserved.

La anatomía neurovascular independiente de la cabeza larga del tríceps braquial y su idoneidad como un colgajo muscular libre han sido ampliamente estudiadas. En cambio, la trasposición de esta porción del tríceps para mejorar la flexión de codo ha sido descrita pocas veces. Se describen en este artículo dos casos de secuela de lesión del plexo braquial, en los que se realizó trasposición únicamente de la cabeza larga del tríceps. Se logró mejorar la flexión del codo y se conservó la extensión del mismo.

[Wrist X ray for analysis of the articular surface of distal radius]. / Evaluación radiológica de muñeca para visualizar la superficie articular del radio.

In the distal radius fracture requires radiographic views that allow you to see the articular surface without interposition. The objective was to determine whether lateral radiographic projections 7 and 22° improve the analysis of this surface. METHOD: Case series study with radiographs of healthy and operated patients, in order to identify the lunate and scaphoid facets in lateral and anteroposterior projections. Qualitative analysis was made on the radiographs of the distal radius with wedges of 7 and 22° in the lateral views and 11° in the anteroposterior view. RESULTS: There were evaluated 14 radiographs of the distal radius of healthy volunteers and 10 patients with distal radius fractures who recieved surgery with internal fixation, and also two anatomical models. In 14 healthy and 10 patients, it was found that the views at 7 and 22° can be better appreciated radio lunate and radio scaphoid surface respectively, observing images with less overlapping in the radiograph of 22° in both groups. DISCUSSION: Radiographic views are important to determine the immediate results of fixation on a distal radius fracture. We observe that the lateral view at 7° is better to show the screws on the lunate facet of the radius. The lateral view at 22° is better to show the facet of the radius with the scaphoid. Finally, the anteroposterior projection at 11° allows us to see the radio carpal joint with lower image overlay.

En la fractura del radio distal se requieren proyecciones radiológicas que permitan ver adecuadamente la superficie articular sin interposición de estructuras. El objetivo fue determinar si las proyecciones radiológicas laterales a 7 y 22° mejoran el análisis de esta superficie. Método: Serie de casos con radiografías de pacientes sanos y operados para identificar las facetas del semilunar y escafoides en las proyecciones lateral y anteroposterior, igualmente se evaluó con tornillos. Se analizaron cualitativamente los hallazgos obtenidos en las radiografías de 7 y 22° para la proyección lateral y de 11° en la anteroposterior. Resultados: 14 radiografías de voluntarios sanos, 10 pacientes con fractura de radio que recibieron osteosíntesis y dos piezas anatómicas. En los 14 sanos y los 10 pacientes se encontró que en las proyecciones a 7 y 22° pueden apreciarse mejor las carillas radio-semilunar y radio-escafoides respectivamente, observando imágenes con menor superposición de estructuras en la radiografía de 22° tanto en los sanos como en los pacientes con fracturas. Discusión: Las proyecciones radiológicas son importantes para poder determinar los resultados inmediatos de una osteosíntesis realizada en una fractura de radio distal. En este estudio se observa que la proyección lateral a 7° identifica mejor la posición de los tornillos ubicados en la carilla semilunar del radio. La proyección lateral a 22° muestra mejor la carilla con el escafoides. Por último en la proyección anteroposterior a 11° nos permite ver la articulación radiocarpiana con menor superposición de imágenes.

Anatomic study of the extensor carpi radialis brevis in its relation with the motor branch of the radial nerve.

INTRODUCTION: The cause of the tunnel syndrome is the entrapment of the posterior interosseous nerve, and can occur due to different anatomic structures, the arcade of Frohse being the main one of them. PURPOSE: To describe the anatomic relation between the extensor carpi radialis brevis (ECRB) muscle and the motor branch of the radial nerve at its entrance under the arcade of Frohse. MATERIALS AND METHODS: An anatomic dissection of 21 elbows of fresh human cadavers was conducted, describing the deep aponeurosis and the superomedial tendinous arch of ECRB and its relation with the motor branch of the radial nerve. RESULTS: In 100% of the specimens, there was evidence of an aponeurosis in the undersurface of ECRB. A tendinous arch at the superomedial margin of ECRB was found in 20 cases (95.2%). In 71.5%, this arch surpassed proximally the arcade of Frohse on an average of 4.5mm (2-10mm); it passes in direct contact with the motor branch of the radial nerve. CONCLUSIONS: The extensor carpi radialis brevis muscle courses in a close relation to the motor branch of the radial nerve at its entrance under the arcade of Frohse, and it demonstrates an aponeurosis at its undersurface and a tendinous arch at its medial edge that could play an important role in the development of the radial tunnel syndrome. LEVEL OF EVIDENCE: Level IV. Anatomic research study.

[Cleft hand: a review of 33 cases and new ideas about classification]. / Les fentes médianes de la main: revue de 33 cas.

Cleft hand is an uncommon congenital malformation, which is defined as a deficiency of the central part of the hand. It is the result of the absence or altered development of the central rays. The aim of treatment is to optimise the function of the hand at a young age and to improve its aesthetics. A retrospective review of 33 cases is presented and, with reference to their treatment, ideas about the classifications of cleft hand are discussed. The various anomalies seen and the management for each type of cleft hand are presented.

[Deep vein thrombosis associated with osteoarticular infection in two siblings with anti-thrombin III deficiency]. / Trombosis venosa profunda asociada a infección osteoarticular en dos hermanos con deficiencia de antitrombina III.

The development of deep vein thrombosis in an osteoarticular infection in children is rare. We report the case of two siblings with an osteoarticular infection in the hip and in the knee, respectively, who developed deep vein thrombosis and, in one sibling, pulmonary thromboembolism. The only hematological alteration found was reduction of anti-thrombin III in both patients. This reduction was acquired and secondary to sepsis due to Staphylococcus aureus. Anti-thrombin III levels recovered after 2 weeks of treatment. The association of deep vein thrombosis and osteoarticular infection with sepsis should lead to suspicion of hematological deficiencies, including acquired anti-thrombin III deficiency.

Trombosis venosa profunda asociada a infección osteoarticular en dos hermanos con deficiencia de antitrombina III / Deep vein thrombosis associated with osteoarticular infection in two siblings with anti-thrombin III deficiency

La aparición de trombosis venosa profunda en la infección osteoarticular en niños es una asociación rara. Comunicamos el caso de dos hermanos con infección osteoarticular de la cadera y de la rodilla, respectivamente, que desarrollaron trombosis venosa profunda, y en uno de ellos, tromboembolismo pulmonar. Sólo se encontró como alteración hematológica disminución de la antitrombina III (AT III) en los dos pacientes. Esta disminución fue adquirida y secundaria a la sepsis que presentaron por Staphylococcus aureus. Las concentraciones de AT III se recuperaron a las 2 semanas de tratamiento. La asociación de trombosis venosa profunda e infección ostearticular con sepsis debe hacernos pensar en deficiencias hematológicas, entre ellas la deficiencia adquirida de AT III

The development of deep vein thrombosis in an osteoarticular infection in children is rare. We report the case of two siblings with an osteoarticular infection in the hip and in the knee, respectively, who developed deep vein thrombosis and, in one sibling, pulmonary thromboembolism. The only hematological alteration found was reduction of anti-thrombin III in both patients. This reduction was acquired and secondary to sepsis due to Staphylococcus aureus. Anti-thrombin III levels recovered after 2 weeks of treatment. The association of deep vein thrombosis and osteoarticular infection with sepsis should lead to suspicion of hematological deficiencies, including acquired anti-thrombin III deficiency