[Capsular hydrodilatation versus kinesitherapy as initial treatment of finger capsulitis]. / Hidrodilatación capsular versus cinesiterapia como tratamiento inicial en las capsulitis de dedos.

INTRODUCTION: To evaluate the effectiveness of early capsular ultrasound-guided hydrodilatation (HD) of the proximal interphalangeal or metacarpophalangeal joints in reducing joint stiffness and shortening kinesitherapy, as well as in improving hand functionality. MATERIAL AND METHODS: We performed a one-year quasi-experimental pretest-posttest study with a control group in patients with proximal interphalangeal or metacarpophalangeal capsulitis in complex regional pain syndrome stages 2 or 3. Inclusion criteria consisted of age over 18 years, visual analogue scale<4 points and the absence of prior treatment. The control group received only kinesitherapy and the experimental group received capsular HD before kinesitherapy. There were 10 patients per group. The main measures were range of motion, active grip, Spanish validated Michigan Hand Outcomes Questionnaire and the number of kinesitherapy sessions required. RESULTS: At baseline, the range of motion of the proximal proximal interphalangeal joint was 20° worse in the experimental group (P=.01). There were no statistically significant differences in the other baseline characteristics. Immediate gain in range of motion after HD was 61.71% (P=.024). No significant improvements were observed in functionality except in active grip after 2 weeks of HD (P=.02) and one month later compared with the control group (P=.014). The number of kinesitherapy sessions required was 19.6±10.42 (95% CI) in the HD group and 29.4±8.11 (95% CI) in the control group (P>.05). CONCLUSIONS: Capsular HD could be considered as an initial treatment in finger joint stiffness because of the significant immediate improvement in range of motion. It is also an innovative technique in these joints with a short learning curve. The technique can be safely and effectively performed in a physiatry consulting room.

Transferencia articular vascularizada: Reporte de caso / Free vascularized joint transfer: Case report

La articulación interfalángica proximal otorga la mayor contribución al arco total de movimiento digital, por lo tanto, la pérdida de movimiento normal de la articulación tiene un impacto considerable en la función y fuerza de agarre. El único método que asegura la preservación a largo plazo de la arquitectura cartilaginosa, así como una curación ósea rápida tras destrucción articular traumática o patológica es la transferencia articular vascularizada. Es definida como un trasplante articular parcial o completo con preservación o restauración inmediata del flujo de sangre. Se presenta el caso de un masculino de 20 años, con antecedente de trauma contuso-cortante en borde cubital de 3er dedo de mano izquierda zona II a quien se realiza cierre primario. Siete meses después a presentó deformidad articular e incapacidad funcional para la flexión de articulación interfalángica proximal. Se realizó procedimiento de reconstrucción articular, mediante transferencia articular vascularizada de 2° dedo del pie derecho. Posteriormente se dio seguimiento a través de consulta externa a las 2, 4, 6 y 8 semanas, 6 meses y 12 meses. A los 6 meses fue sometido a capsulotomía, liberación de placa volar, retiro de placas de osteosíntesis y adelgazamiento de isla cutánea. Se alcanzaron rangos de movimiento pasivo de extensión de 85° y activo de 70°. En base a la experiencia de nuestro centro se demuestra que el uso de transferencia articular en 2 etapas de reconstrucción, se pueden mantener rangos de movimiento tanto activo como pasivo suficiente para una adecuada función.

The proximal interphalangeal joint provides the greatest contribution to the total arc of digital movement, therefore, the loss of normal movement of the joint has a considerable impact on function and grip strength. The only method that ensures the long-term preservation of the cartilaginous architecture, as well as a rapid recovery of traumatic or pathological joint destruction, is vascularized joint transfer. It is defined as a partial or complete partial transplant with preservation or immediate restoration of blood flow. We present the case of a 20-year-old man, with a history of contusive-cutting trauma on the ulnar border of the third finger of the left hand, area II, who underwent primary closure. Seven months after the presentation of the joint and functional disability for proximal interphalangeal joint flexion. A joint reconstruction process was performed, by means of a vascularized joint transfer of the 2nd toe of the right foot. Subsequently, follow-up was carried out through the outpatient clinic at 2, 4, 6 and 8 weeks, 6 months and 12 months. At 6 months he was subjected capsulotomy, volar plate release, osteosynthesis plates removal and cutaneous island thinning. Ranges of passive movement of extension of 85° and active of 70° were reached. Based on the experience of our center, it is shown that the use of the transfer was made in 2 stages of reconstruction, the range of both active and passive movements can be maintained for an adequate function.

Arthrodesis of the proximal interphalangeal joint of the 4th and 5th finger using an interlocking screw device to treat severe recurrence of Dupuytren's disease. / Artrodesis de la articulación Interfalángica proximal del 4.° y 5.° dedo utilizando un dispositivo de tornillos entrelazados a compresión en el tratamiento de la recidiva grave de la enfermedad de Dupuytren.

OBJECTIVE: To assess the radiological and functional outcome of arthrodesis of the 4th and 5th finger using the APEX™ (Extremity Medical, Parsippany,NJ)intermedullary interlocking screw system in patients with severe recurrence of Dupuytren's disease. MATERIAL AND METHOD: The DASH questionnaire and the VAS scale were used to assess the clinical outcomes. The angle of arthrodesis, fusion time and implant fixation were evaluated on x-rays. The patients were monitored for complications during surgery and the follow-up period. RESULTS: The sample comprised 6 patients. Mean follow up was 19.6 months. All of the patients presented clinical and radiological evidence of fusion at 8 weeks, with fusion angles of 30° (3) and 45° (3). There were no complications and none of the implants had to be removed. The functional outcomes in these patients were poor. CONCLUSION: The system offers a reliable method for IPJ arthrodesis at a precise angle. It promotes stable fixation that does not require prolonged immobilisation. It can be used together with other procedures on the hand with severe recurrence of DD. The functional outcomes for this group of patients using this device were poor.

Uso de férulas correctoras en la rigidez de la articulación interfalángica proximal como consencuencia de un traumatismo / Corrective splints in the stiffness of the proximal interphalangeal joint as a result of trauma

La pérdida de rango de movimiento pasivo (PROM) en las articulaciones interfalángicas de la mano es una secuela común tras lesiones traumáticas. A pesar de que el uso de férulas se ha convertido en una modalidad terapéutica ampliamente aceptada para mejorar el PROM, existe muy poca evidencia empírica que guíe en la prescripción de férulas. El presente estudio investiga el efecto del uso de férulas correctoras en contracturas en fexión de la articulación interfalángica proximal (IFP) de los dedos de la mano tras una lesión traumática. Diecisiete pacientes con una contractura en fexión de la IFP tras una lesión traumática como consecuencia de un accidente laboral participaron en este estudio experimental. Mediante un goniómetro digital se valoró el PROM de la articulación IFP de dichos pacientes y se les asignó de manera aleatoria a uno de los dos grupos de férulas. A los pacientes del grupo A se les colocó una férula de extensión dinámica de la IFP y a los del grupo B se les colocó una férula de extensión estática. El PROM de la articulación se volvió a valorar con un goniómetro en el momento en el que los pacientes recibieron el alta laboral. Los resultados indicaron mejorías signifcativas en ambos grupos en la corrección de la contractura en fexión (p<0,05). La diferencia entre los pacientes que usaron la férula dinámica frente a los que usaron la férula estática no fue estadísticamente signifcativa. Ambos tipos de férulas pueden ser recomendadas para el tratamiento de contracturas en fexión inferiores a 35º de la IFP tras una lesión traumática.

Reduced passive range of motion (PROM) of the interphalangeal joints of the hand is a common consequence after a traumatic injury.Although mobilizing splinting has become a rehabilitative approach widely accepted by therapists to improve PROM, limited empirical evidence is available to guide in its prescription. This study investigates the effect of corrective splinting on fexion contracture of the fnger proximal interphalangeal joints (PIP) after a traumatic injury of the hand. Seventeen patients with fnger fexion contracture of the PIP as a result of an industrial accident participated in the experimental study. The passive range of motion of the PIP joint was measured with a fnger goniometer and patients were randomly allocated to one of two splint programs. Subjects in group A were given dynamic extension splints, and subjects in group B were given static splints. PROM was re- assessed with a goniometer once the patient was discharged and started working again. Results indicated signifcant improvement in both groups in the correction of the fnger fexion contracture (p<0,05). Patients with dynamic fnger extension splints did not differ signifcantly from those with static splints in extension gains. Both types of splints can be recommended for fexion contractures of 35 degrees or less in the PIP joint after a traumatic injury.

Quiste subcondral a nivel de la articulación interfalángicaproximal en una potranca criolla colombiana: reporte de caso / Subchondral cyst in the proximal interphalangeal joint in a paso fino colombian horse: a case report / Cisto subcondral na articulação proximal interfalângicaem um potro crioulo colombiano: relato de caso

Se reporta el caso de una paciente equina, evaluada por Especial•Vet práctica privada, la cual presentaba alexamen clínico ortopédico un grado de claudicación II/V en ambos miembros posteriores (según clasificaciónde la AAEP), la cual no presento mejoría después de realizar un tratamiento médico de tipo parenteral confenilbutazona. Posteriormente se realizó un nuevo examen clínico ortopédico en el cual se realizó bloqueoanestésico perineural abaxial en ambos miembros posteriores encontrando una mejoría del 90% con respectoal grado de claudicación inicial. Se realizó evaluación radiológica digital, con las siguientes proyecciones:dorso plantar y lateromedial en las cuales se evidenció un área radiolúcida circunscrita a nivel del terciodistal de la primera falange, con comunicación a la articulación interfalángica proximal en ambos miembros posteriores, seguidamente se realizó evaluación ultrasonográfica en la cual se observa un área anecóica y lafalta de continuidad de la superficie ósea a nivel de la articulación interfalángica proximal de ambos miembrosposteriores. Estableciendo de esta forma como diagnóstico definitivo quiste subcondral a nivel del tercio distalde la primera falange, con comunicación a la articulación interfalángica proximal. Se realizó infiltración conacetato de triamcinolona, betametasona y ácido hialurónico a nivel intrarticular; antibioterapia de maneraprofiláctica al procedimiento, descanso en pesebrera por 4 semanas y reincorporación al ejercicio de maneraprogresiva, suministro de complementos condroprotectores de manera enteral (Flexequin® 40 gr/día VO yCortaflex® 20 ml/día VO). Al momento de la publicación de este artículo, la paciente no presenta ningún gradode claudicación y se encuentra realizando un trabajo físico y atlético normal.

We report the case of an equine patient, assessed by Especial Vet private practice, whose orthopedic clinicalexamination showed a degree of lameness II / V in both hind limbs (according to AAEP classification), whichdemonstrated no improvement after medical treatment with parenteral phenylbutazone. Subsequently a neworthopedic clinical examination was performed in which an abaxial, perineural anesthetic block was applied to both hind legs, which produced 90% improvement compared to the initial degree of lameness. Digital radiographicevaluation was performed with the following results: dorsal-plantar and lateral-medial images which showeda circumscribed, radiolucent area at the level of the distal third of the first phalanx, with communication to theproximal interphalangeal joint on both hind limbs. Following, an ultrasound evaluation was carried out in whichthere was an anechoic area and lack of continuity of the bone surface at the proximal interphalangeal joint of bothhind limbs. These findings established a definitive diagnosis of a subchondral bone cyst at the distal third of the firstphalanx, with communication to the proximal interphalangeal joint. Intra-articular infiltration was performed with triamcinolone acetonide, betamethasone and hyaluronic acid; antibiotics as prophylaxis, rest in a stable for 4 weekswith a gradual return to exercise, and provision of enteral, chondroprotective supplements (p.o. Flexequin ® 40 gr/day and p.o. Cortaflex ® 20ml/day). At the time of publication of this article, the patient does not present any degreeof lameness and is performing normal athletic and physical activity.

Relatamos um caso de um paciente eqüino, avaliado pela prática privada Especial Vet, cujo exame clínicoortopédico mostrou um grau de claudicação II / V em ambos os membros posteriores (de acordo com aclassificação do AAEP), o qual não demonstrou melhora após o tratamento médico com fenilbutazona parenteral.Após a aplicação de um bloqueio anestésico perineural abaxial em ambas as pernas traseiras, foi realizadoum novo exame clínico ortopédico, mostrando uma melhora de 90% em comparação com o grau inicial declaudicação. Realizou-se também uma avaliação radiográfica digital obtendo-se os seguintes resultados: imagensdorso-plantar e latero-medial que mostrou uma área radiolúcida circunscrita ao nível do terço distal da primeirafalange, com comunicação para a articulação interfalângica proximal em ambos os membros posteriores. E após,a realização de um ultra-som, verificou-se que houve uma área anecóica e falta de continuidade da superfície óssea ao nível da articulação interfalângica proximal dos dois membros posteriores. Desta forma estabeleceu umdiagnóstico definitivo de um cisto ósseo subcondral no terço distal da primeira falange, com comunicação para aarticulação interfalângica proximal. Uma infiltração intra-articular foi realizada com acetato de triamcinolona,betametasona e ácido hialurônico; antibióticos como profilaxia, um descanso em estábulo durante 4 semanas, com um retorno gradual aos exercícios, e administração de suplementos condroprotetores de maneira enteral(Flexequin® 40 gr/día VO e Cortaflex® 20 ml/día VO). No momento da publicação deste artigo, o paciente nãoapresenta qualquer grau de claudicação e está realizando atividades atléticas e físicas normais.

Estudio comparativo de artrodesis de dedos: banda de tensión vs tornillo compresivo / Finger atrhodesis: a comparative study with tension band a fusion technique

Objective: There are many different techniques for finger arthrodesis our purpose is to compare the results of metarcophalangeal (MP) and proximal interphalangeal (PIP) joint arthrodesis, with tension band wire technique vs compression screw. Methods: Retrospective cohort study of patients with arthrodesis of the MP and PIP joint between 2006 and 2009, with a tension band wire technique (N = 28) and Mini-Acutrak screw (N = 29). We compared rates and times of union and the incidence of complications. Results: The union rate of the tension band group was 92.9 percent and 85.7 percent for the screw group, at 9.4 and 9.8 weeks respectively. The complications rate was 28.6 percent for tension band wire technique and 27.6 for the screw technique. The reoperation rate was 32.1 percent for the tension band wire technique and 3.6 percent for the screw group, with remove of 25 percent of the tension band. Discussion: Both surgical techniques had a similar rate of union and complications, but with significantly more re-operation to remove implants in the tension band group, which is an important factor to consider when choosing the surgical technique.

Objetivo: Existen múltiples técnicas de atrodesis de dedos, por lo que nuestro objetivo es compara resultados de artrodesis de metacarpofalángicas e interfalángicas proximales de los dedos mediante banda de tensión vs tornillo compresivo. Material y Método: Se realizó un estudio de cohorte retrospectivo, comparativo, de pacientes operados de artrodesis interfalángica proximal o metacarpofalángica de lo dedos primarias entre los años 2006 y 2009. Se analizaron 28 pacientes con banda de tensión y 29 con técnica de tornillo compresivo sin cabeza Mini-Acutrak, comparando tasas y tiempos de consolidación e incidencia de complicaciones. Resultados: Se obtuvo una tasa de consolidación de 92,9 por ciento para el grupo banda de tensión y 85,7 por ciento para el grupo de tornillos, a las 9,4 y 9,8 semanas respectivamente (sin diferencia significativa para ambas variables). La tasa de complicaciones fue de 28,6 por ciento para la bandea de tensión y de 27,6 por ciento para la técnica con tornillo. La tasa de reoperaciones fue de 32,1 por ciento para la técnica con banda de tensión y de 3,6 por ciento con tornillo, determinado por el 25 por ciento de las bandas de tensión, sin haber retiro de tornillos. Discusión; Ambas técnicas quirúrgicas muestran una similar tasa de consolidación y complicaciones, pero existe unna significativa mayor tasa de reoperaciones para el retiro de material de osteosíntesis en el grupo de banda de tensión, lo cual es un factor importante a considerar en la elección de la técnica quirúrgica, siendo en este sentido, el tornillo una mejor opción.