Artroplastia de fijación con hemibandeleta del palmar mayor en el tratamiento de la rizartrosis: Resultados preliminaries / Fixing arthroplasty with a slip of major palmar in the treatment of the trapeziometacarpal arthrosis: preliminary results

Objetivo: Evaluar los primeros resultados tras la realización de una artroplastia de fijación e interposición utilizando una bandeleta cubital del tendón palmar mayor en el tratamiento de la rizartrosis. Material y método: Desde abril de 2014 hasta enero de 2017, 16 pacientes con rizartrosis en estadio 3 y 4 de Eaton fueron intervenidos con hemitrapeziectomia y reconstrucción ligamentosa utilizando una plaslos pacientes fue de 64,3 (DS 7,4) años. El seguimiento medio postquirúrgico fue de 20,7 (DS 10,6) meses. Resultados: Los resultados funcionales según la clasificación Green y O'Brien fueron excelentes en 4 pacientes (25%), buenos en 10 pacientes (62,5%) y regulares en 2 pacientes (12,5%). La escala Quick-Dash preoperatoria pasó de 74,8 (DS 10,6) puntos a 10,8 (DS 9,9) puntos al final del seguimiento. De acuerdo a la escala Mayo, la muestra tenía una media de 85,4 (DS 14,6) puntos. Radiográficamente, no encontramos colapso articular trapecio-metacarpiano al final del seguimiento. Conclusiones: Esta técnica permite reproducir la función de los ligamentos trapeciometacarpianos y al realizar una plastia de fijación de la base del primer metacarpiano, lo estabiliza y evita el colapso articular, consiguiendo una articulación indolora y estable, con un buen arco de movilidad del pulgar. Los resultados clínicos y radiológicos al final del seguimiento son buenos y esperanzadores pero se necesita un mayor número de pacientes y mayor seguimiento para obtener conclusiones más definitivas

Purpose: To evaluate the early results after the fixing and interposition artroplasty using a cubital slip of the flexor carpi radialis for the treatment of ostheoarthritis of the thumb. Methods: From April 2014, to January 2017, 16 patients with ostheoarthritis of the thumb in stage 3 and 4 of Eaton underwent reconstruction with hemitrapeziectomy and ligaments reconstruction using a plasty of the palmar major. Mean patient age at surgery was 64, 3 (DS 7, 4) years. The minimum follow-up was 20, 7 (DS 10, 6) months. Results: The functional outcome according to Green and O’Brien score was excellent in 4 patients (25%) good in 10 patients (62, 5%) and satisfactory in 2 patients (12, 5%). The mean according Quick-Dash score was 74, 8 (DS 10, 6) points before the surgery to 10.8 (DS 9, 9) points at the end of the follow-up and according modified Mayo score, the result was 85, 4 (DS 14, 6) points. On the X-rays, there isn't collapse postoperative and the end of the follow-up. Conclusions: This technique enables to simulate the function of carpometacarpal ligaments and to perform a fixing arthroplasty of the base of the first metacarpal to stabilizes it and avoids the collapse of the joint, getting a painless and stable joint, with a good range motion of the thumb. The clinical and radiographic findings at follow-up were good and encouraging but more patients and longer follow-up is needed to reach definitive conclusions

[A case of dislocation of a double patella]. / Un cas de rotule double luxée.

The congenital dislocation of the patella is relatively rare and the duplicated patella associated is exceptional. The congenital character of the dislocation is unquestionable, but the etiology remains unknown. Before patellar ossification, the diagnosis is difficult and may be delayed for several years until progressive genu valgum, external tibial rotation and flexion deformity results. Radiographs are not useful in evaluating the dislocation until patellar ossification begins at approximately 4 years of age. CT scans and MR imaging reveal the diagnosis before patellar ossification and defines the magnitude of associated dysplasia and the presence of degenerative changes. Early treatment is recommended before the development of secondary bony deformity. We are reporting an unusual case of a woman with multiple epiphyseal dysplasia and bilateral congenital malformation of the patella (duplicated frontal type), associated with genu valgum and congenital dislocation of the patella. She was diagnosed at 31 years old. After surgical treatment (genu valgum correction by varus osteotomy, proximal and distal realignment of the extensor mechanism and osteosynthesis with screws of duplicated patella) and three years follow-up period, we have obtained a good result (painless knees, no recurrence of dislocation and active flexion of 100 degrees on the right knee and 120 degrees on the left knee).