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1.
J Hand Surg Am ; 37(5): 889-98, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22483180

RESUMEN

PURPOSE: For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast. METHODS: Over a 2-year-period, a prospective, randomized, multicenter study was conducted at 4 hospitals in Switzerland. Clinical and radiological results of 66 consecutive patients having 75 extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Intra-articular and physeal fractures, pathological fractures, open fractures, concomitant injuries of the tendons or collateral ligaments, and accidents more than 7 days before presentation were excluded from the study. RESULTS: Radiographically, there were no statistically significant differences between the 2 groups in terms of palmar apex angulation and radial or ulnar angulation. There were no differences in total active range of finger motion. Wrist joint motion at the time of cast removal was statistically superior in patients treated with Lucerne cast. However, there were no significant differences in wrist joint motion at 12 weeks of follow-up. CONCLUSIONS: The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. Well-reduced, minimally angulated, or nonangulated fractures of the proximal phalanges of the fingers can be effectively treated using functional casts without immobilizing the wrist. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.


Asunto(s)
Falanges de los Dedos de la Mano/lesiones , Fracturas Óseas/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Tirantes , Moldes Quirúrgicos , Femenino , Falanges de los Dedos de la Mano/diagnóstico por imagen , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Suiza , Resultado del Tratamiento
2.
Radiologe ; 52(7): 621-8, 2012 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-22710989

RESUMEN

CLINICAL/METHODICAL ISSUE: Hand and wrist pain remains a diagnostic challenge, both for hand surgeons and for radiologists. Especially chronic wrist pain is often hard to localize clinically and further cross-sectional imaging is often indispensable. STANDARD RADIOLOGICAL METHODS: The well-established standard for non-invasive diagnostic imaging in chronic wrist pain is magnetic resonance imaging (MRI). METHODICAL INNOVATIONS: Recently, state-of-the-art single photon emission computed tomography/computed tomography (SPECT/CT) systems have been introduced into the diagnostic array for musculoskeletal conditions. Besides morphological data SPECT/CT also provides metabolic information. PERFORMANCE: SPECT/CT allows an exact detection and precise anatomical mapping of different pathologies of the wrist, which is often crucial for therapy. ACHIEVEMENTS: In patients with chronic wrist pain, SPECT/CT is more specific than MRI. It is also beneficial in patients with posttraumatic conditions and metal implants and may serve as a problem-solving tool in difficult cases. PRACTICAL RECOMMENDATIONS: It is considered that SPECT/CT imaging is useful if MRI results are equivocal or present no clearly leading pathology. A primary examination with SPECT/CT seems to be a reasonable option for patients with certain bone pathologies, metal implants and non-specific wrist pain.


Asunto(s)
Articulaciones de la Mano/diagnóstico por imagen , Aumento de la Imagen/métodos , Artropatías/diagnóstico por imagen , Humanos , Radiografía , Cintigrafía
3.
Handchir Mikrochir Plast Chir ; 40(3): 201-3, 2008 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-18543160

RESUMEN

Avascular necrosis of the hamate is a very rare condition. After repetitive stress a young male developed left wrist pain which was found to be an avascular necrosis of the hamate. After progression of the necrosis with cyst formation on follow-up magnetic resonance imaging (MRI) and persisting pain, the patient underwent successful revascularisation with a vascular bone graft of the distal radius.


Asunto(s)
Hueso Ganchoso/cirugía , Osteonecrosis/cirugía , Adulto , Trasplante Óseo , Hueso Ganchoso/lesiones , Hueso Ganchoso/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Osteonecrosis/diagnóstico , Muñeca/patología , Muñeca/cirugía
4.
Handchir Mikrochir Plast Chir ; 40(3): 175-81, 2008 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-18543162

RESUMEN

Trapeziometacarpal arthrosis is the second most common disorder in the field of degenerative joint diseases of the hand, appearing ten to fifteen times more often in females older than 50 than in men of the same age group. Thus, an age group is afflicted where the hands are needed for occupational activity in addition to the physical strain of constant housework. However, no systematic data concerning the postoperative ability to perform household and or occupational activities have been reported. The aim of this study is to give better advice to future patients during office visits prior to the operation. For this, we evaluated different professions, postoperative working ability, occupational rehabilitation (housework or occupational activity), remaining discomfort and complications. We used a list of questions including the DASH questionnaire and sent it to patients after performing a tendon interposition arthroplasty. Forty-seven of the 52 patients of working age and under the age of 60 years returned the questionnaire. Patients were, according to their profession, classified into 4 different groups: manually heavy work, manually light work, office work and housework. Judging from the recorded data, we conclude that approximately 90% of the patients regained their preoperative working ability. Patients were unable to work for an average period of 8 weeks postoperatively and could only work part-time (50%) for another 8 weeks. There is a positive correlation between incapacity and the kind of work to be performed. Housewives/-men returned approximately to their preoperative status of working ability after a period of three months. Light pain is possible. The risk of disability pension due to persistent painful inability to use the hand is rather low despite the operation. Manually light working people evaluate the outcome of the operation as less good than manually heavy working people, office workers or housewives/-men.


Asunto(s)
Articulaciones Carpometacarpianas/cirugía , Terapia Ocupacional , Osteoartritis/cirugía , Complicaciones Posoperatorias/rehabilitación , Rehabilitación Vocacional , Transferencia Tendinosa/métodos , Hueso Trapecio/cirugía , Adulto , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ocupaciones , Dimensión del Dolor , Reoperación , Encuestas y Cuestionarios
5.
Hand Surg Rehabil ; 37(2): 124-125, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29452880

RESUMEN

Most extra-articular fractures of the proximal phalanges (P1) of the triphalangeal fingers can be treated conservatively with good results. Prerequisites for successful fracture treatment are intact soft tissue without any lesions of the extensor hood and stable initial fracture reduction. The key to functional conservative treatment of P1 fractures is to immobilize the metacarpophalangeal joints in flexion, resulting in equilibrium of flexor and extensor forces across the fracture site, which converts these inherently unstable fractures into relatively stable fractures. Precise initial application of the cast and regular follow-up of the patient is essential for successful treatment. By means of an instructional video, an overview of the equipment required is given, and the correct application of a Lucerne Cast is illustrated step-by-step.


Asunto(s)
Moldes Quirúrgicos , Falanges de los Dedos de la Mano/lesiones , Fracturas Óseas/terapia , Tratamiento Conservador , Contraindicaciones de los Procedimientos , Humanos
6.
J Hand Surg Eur Vol ; 40(9): 914-23, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25409115

RESUMEN

UNLABELLED: Recently the decision-making committee of the compulsory Swiss accident insurance scheme needed to make a basic decision as to whether to fund hand transplantation under that scheme or not. A Health Technology Assessment was commissioned to inform decision-making and gain experience with applicability of the method. The following were main findings from various domains. Compared with prosthesis fitting, the outcome of hand transplantation is satisfactory for function and sensibility. Complications due to immunosuppression are frequent, sometimes severe and potentially life-shortening. The direct medical costs over the entire life span calculated for a 35-year-old unilaterally amputated base case patient were CHF 528,600 (EUR 438,500) higher than for a prosthesis. There are challenging ethical, legal and organizational issues. The committee decided not to reimburse hand transplantation for ethical reasons. The Health Technology Assessment has been shown to be a useful tool for decision-making in the context of Swiss accident insurance. LEVEL OF EVIDENCE: IV.


Asunto(s)
Comités Consultivos , Trasplante de Mano/economía , Seguro por Accidentes , Reembolso de Seguro de Salud , Análisis Costo-Beneficio , Toma de Decisiones , Humanos , Modelos Económicos , Suiza
7.
Eur J Pediatr Surg ; 1(4): 221-6, 1991 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-1931841

RESUMEN

Severe crush injuries with open comminuted fractures of the lower extremity often result in extensive tissue loss. In such a situation early free microsurgical tissue transplantation offers most effective possibilities of treatment. Among others, two of the most eminent advantages of free microsurgical tissue transplantation are: 1. The possibility of tissue replacement which cannot be achieved by traditional procedures such as functional muscle transplantation or the replacement of extremely extensive tissue loss; moreover immediate or early bone coverage by well vascularized soft-tissue is most effective in the prevention of infection. 2. In many cases complete reconstruction can be achieved by a one-stage-procedure: this decreases the morbidity considerably. These advantages are demonstrated by clinical cases, where we used free microsurgical tissue transplantation.


Asunto(s)
Fracturas Abiertas/cirugía , Traumatismos de la Pierna/cirugía , Amputación Traumática/cirugía , Trasplante Óseo/métodos , Niño , Fijadores Externos , Humanos , Traumatismos de la Pierna/rehabilitación , Masculino , Músculos/lesiones , Piel/lesiones , Colgajos Quirúrgicos , Trasplante Autólogo
8.
J Hand Surg Br ; 24(6): 731-4, 1999 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-10672814

RESUMEN

The hypothenar hammer syndrome is an uncommon lesion of the ulnar artery caused by repetitive trauma to the ulnar portion of the hand. It characteristically occurs in the dominant hand of middle-aged craftsmen, but also in athletes practising various types of sports. We present a retrospective study of nine patients between 1988 and 1999. The follow-up ranged from 1 to 10 years. We recommend surgical treatment, by resection of the involved arterial segment and revascularization either by direct anastomosis or by means of a venous interpositional graft.


Asunto(s)
Arteria Cubital/lesiones , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma/diagnóstico , Aneurisma/etiología , Aneurisma/cirugía , Trastornos de Traumas Acumulados/diagnóstico , Trastornos de Traumas Acumulados/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/cirugía
9.
Chirurg ; 66(5): 534-6, 1995 May.
Artículo en Alemán | MEDLINE | ID: mdl-7607020

RESUMEN

Amoebic appendicitis is very rare, occurring in about 0.5 to 1% of acute appendicitis in tropical countries. The most severe complication is transmural amoebic colitis with perforation, described in 1.6 to 3.2% of cases. The mortality of such cases can be very high (up to 80%). We present a Swiss patient with amoebic appendicitis followed by severe perforated colitis; a total colectomy was necessary and the patient survived. Because of the good results of amoebicidal therapy and because of the severity of the complication after colitis we suggest that patients with signs of acute appendicitis after travel in tropical areas should be screened.


Asunto(s)
Apendicitis/cirugía , Colitis/cirugía , Disentería Amebiana/cirugía , Perforación Intestinal/cirugía , Anciano , Animales , Apendicectomía , Apendicitis/patología , Apéndice/patología , Colectomía , Colitis/patología , Colon/patología , Disentería Amebiana/patología , Entamoeba histolytica/ultraestructura , Humanos , Perforación Intestinal/patología , Masculino
10.
Handchir Mikrochir Plast Chir ; 30(5): 335-7, 1998 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-9816516

RESUMEN

One year after a nonspecific trauma and with a history of pain of four weeks only, an osteoid osteoma of the first phalanx of the left thumb was diagnosed in a 31-year-old man. The radiologic appearance as well as a bone scan were suggestive for an osteoid osteoma. The diagnosis was confirmed histologically after resection of the tumor. As indicated in the literature, osteoid osteoma of the hand is relatively rare. The symptoms and radiologic features (osteolytic nidus and sclerosis) of osteoid osteomas are independent of the tumor location. Surgery with resection of the nidus is the only known curative therapy. The etiological role of trauma is discussed and a review of the literature is done with 15 other cases of posttraumatic osteoid osteoma having been reported.


Asunto(s)
Neoplasias Óseas/cirugía , Osteoma Osteoide/cirugía , Dolor/etiología , Pulgar/lesiones , Adulto , Neoplasias Óseas/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Osteoma Osteoide/diagnóstico , Pulgar/cirugía
11.
Handchir Mikrochir Plast Chir ; 33(2): 113-6, 2001 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-11329888

RESUMEN

Three cases of closed extensor tendon ruptures without osseous involvement in Verdan's zone 1 of the thumb (Mallet thumb) are presented and the various treatment options discussed based on the pertinent literature. As a consequence of the special anatomy of the thumb's extensor tendons which differs from that in the fingers, we recommend surgical treatment of this rare lesion by transosseous refixation of the ruptured tendon. Thus, early postoperative motion can be initiated resulting in rapid recovery of complete function.


Asunto(s)
Traumatismos de los Tendones/cirugía , Pulgar/lesiones , Adulto , Tornillos Óseos , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología , Rotura , Suturas , Traumatismos de los Tendones/etiología , Cicatrización de Heridas/fisiología
12.
Chir Main ; 21(3): 202-5, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-12116834

RESUMEN

A case of cavernous haemangioma arising from the superficial palmar arch is described. The initial symptoms were those of a subacute tenosynovitis. Surgical exploration showed that the tumor was not affecting the flexor tendons. It was completely resected and the patient had full recovery of hand function.


Asunto(s)
Hemangioma Cavernoso/diagnóstico , Tenosinovitis/diagnóstico , Arteria Cubital/patología , Neoplasias Vasculares/diagnóstico , Diagnóstico Diferencial , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/cirugía , Humanos , Masculino , Persona de Mediana Edad , Dolor/etiología , Resultado del Tratamiento , Arteria Cubital/cirugía , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugía
13.
Schweiz Rundsch Med Prax ; 80(41): 1109-12, 1991 Oct 08.
Artículo en Alemán | MEDLINE | ID: mdl-1947539

RESUMEN

In cases with direct nerve repair we consider a plaster cast immobilization of three weeks as adequate; for those with nerve grafts, two weeks are sufficient. In the later course, the patient should regularly be examined also for Tinel's sign, to make sure that this progresses distally corresponding to normal nerve regeneration. If after four to five months the Tinel's sign has not progressed distally, the regenerating nerve fibres are most likely to be blocked by scar tissue formation, and revisional surgery may be indicated. As in all surgery of the hand, the role of a postoperative hand therapy program is of critical importance. In many cases specific sensory reeducation may definitely contribute to improve the final functional result after restoration of peripheral nerves.


Asunto(s)
Nervios Periféricos/cirugía , Causalgia/rehabilitación , Terapia por Estimulación Eléctrica/métodos , Humanos , Regeneración Nerviosa , Neuralgia/rehabilitación , Neurocirugia/rehabilitación , Parestesia/rehabilitación , Traumatismos de los Nervios Periféricos , Nervios Periféricos/fisiología , Modalidades de Fisioterapia/métodos , Cuidados Posoperatorios
14.
J Hand Surg Eur Vol ; 39(5): 505-9, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-23695151

RESUMEN

Nineteen fingertip amputations with exposed bone were treated with a semi-occlusive dressing. The quantity and quality of the regenerated soft tissue was examined. In all 19 fingers there was sufficient uncomplicated healing such that secondary surgical procedures were not needed. At follow-up 6-18 months after the injury, soft tissue thickness around the bone of the distal phalanx measured 6.0 mm (SD 1.6) on the palmar aspect (opposite side 7.0 mm (SD 0.8)) and 4.2 mm (SD 1.7) distally (opposite side 4.5 mm (SD 0.8)). The two-point discrimination was 4 mm (SD 2) (opposite side 3 mm (SD 1)). The skin healed almost without scarring and the dermal ridges reformed. The regeneration of the soft tissue thickness to almost 90% of its former extent is higher than we expected.


Asunto(s)
Amputación Traumática/terapia , Traumatismos de los Dedos/fisiopatología , Traumatismos de los Dedos/terapia , Dedos/fisiología , Apósitos Oclusivos , Regeneración , Adulto , Anciano , Femenino , Traumatismos de los Dedos/patología , Dedos/patología , Humanos , Hipertrofia , Masculino , Persona de Mediana Edad
16.
Handchir Mikrochir Plast Chir ; 43(5): 295-7, 2011 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-21935848

RESUMEN

The recent literature shows that a negative ulnar variance could pose a risk factor for scaphoid fractures.The aim of the current study was to determine whether the ulnar variance also affects the healing of a scaphoid fracture.2 cohorts of 50 patients each, with either a scaphoid fracture or a non-union, were retrospectively compared. The ulnar variance was measured on the X-rays using the Gelberman method.The average value of the ulnar variance in patients with a scaphoid fracture was -1.0 mm. The negative ulnar variance was measured in 64% of the patients. In the second group with scaphoid non-union, the average value of ulnar variance was -0.8 mm. The negative ulnar variance was similarly high, in 68% of the patients. Our results demonstrated almost identical values in both groups with regard to ulnar variance or its distribution, neutral, negative or positive, without statistical significance.Thus, we can exclude the negative ulnar variance as a risk factor for the development of non-union in cases of scaphoid fractures.


Asunto(s)
Curación de Fractura/fisiología , Fracturas Óseas/fisiopatología , Seudoartrosis/fisiopatología , Hueso Escafoides/lesiones , Cúbito/fisiopatología , Articulación de la Muñeca/fisiopatología , Adulto , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Hueso Escafoides/fisiopatología , Adulto Joven
17.
Handchir Mikrochir Plast Chir ; 41(1): 38-43, 2009 Feb.
Artículo en Alemán | MEDLINE | ID: mdl-18777469

RESUMEN

Chronic traumatic aneurysm of the distal radial artery is rare. The literature offers only 20 cases of chronic traumatic vascular lesions of the thenar region. We present the case of a 58-year-old cheese maker who had done manual work for years and who experienced swelling at the thenar eminence, pain, cold and warm paresthesia and circulatory disturbance in his index finger. Duplex ultrasound and CT angiography revealed an aneurysm of the superficial branch of the radial artery indicating a thenar hammer syndrome. He was subjected to a microsurgical end-to-end repair after resection of the aneurysm. This is the first closely documented case of a true aneurysm of the superficial branch of the radial artery. We also present a comprehensive survey of published studies of chronic vascular lesions of the thenar region related to thenar hammer syndrome and patient occupation, symptoms, diagnostis and therapy.


Asunto(s)
Aneurisma/diagnóstico , Trastornos de Traumas Acumulados/diagnóstico , Enfermedades Profesionales/diagnóstico , Arteria Radial/lesiones , Pulgar/irrigación sanguínea , Vibración/efectos adversos , Anastomosis Quirúrgica , Aneurisma/etiología , Aneurisma/cirugía , Angiografía , Trastornos de Traumas Acumulados/complicaciones , Diagnóstico Diferencial , Dedos/irrigación sanguínea , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/cirugía , Masculino , Microcirugia , Persona de Mediana Edad , Enfermedades Profesionales/etiología , Enfermedades Profesionales/cirugía , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex
18.
Handchir Mikrochir Plast Chir ; 41(5): 306-11, 2009 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-19790026

RESUMEN

PURPOSE: This study compares the clinical results of microsurgical nerve repairs in unilateral digital arterial-nerve-injuries with and without repair of the finger artery. PATIENTS AND METHODS: Between January 2000 and May 2007 a total of 81 patients with unilateral digital vascular nerve bundle lesions, including concomitant soft-tissue tendon lesions, were operated on the emergency day. Forty of the 56 patients treated with a nerve repair alone took part in a follow-up after an average of 47 (7-87) months. Twenty of the 25 patients treated with a microsurgical arterial and nerve repair took part in a follow-up after an average of 12 (6-66) months; 3 patients were excluded due to a negative digital Allen-test. In addition to anamnestic data, peripheral nerve function was evaluated by the static and the moving two-point discrimination test, and by Semmes-Weinstein pressure aesthesiometer in the autonomous zone of the affected side of the injured finger. Stereognosis also was examined. The patency of the reconstructed digital artery was tested by a digital Allen-test. RESULTS: No statistically significantly worse results were found in patients with a nerve repair alone compared to patients with additional repair of the finger artery. CONCLUSION: Repair of the finger artery therefore appears to offer no improvement of the clinical outcome following nerve repair in unilateral injury of a digital arterial-nerve bundle.


Asunto(s)
Arterias/lesiones , Traumatismos de los Dedos/cirugía , Dedos/irrigación sanguínea , Dedos/inervación , Mecanorreceptores/fisiología , Microcirugia/métodos , Traumatismos de los Nervios Periféricos , Complicaciones Posoperatorias/fisiopatología , Tacto/fisiología , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica/métodos , Arterias/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Regeneración Nerviosa/fisiología , Nervios Periféricos/cirugía , Estudios Retrospectivos , Adulto Joven
19.
Helv Chir Acta ; 58(3): 313-8, 1991 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-1769851

RESUMEN

By the case of a subtotal traumatical amputation of the penis seen in our services, we discuss the advantages of a replantation by microsurgical technique. After presentation of the operational procedure and the management of the postoperative course the results of a thorough examination by questioning, physical examination, neurological examination including EMG testing of the bulbo-cavernous-reflex, Rigiscan NTM and angiography of the penal arteries are discussed. A review of the literature shows the advantages of the microsurgical technique but also the astonishing results by the former, conventional technique which still presents a possibility if microsurgery is not available.


Asunto(s)
Pene/lesiones , Reimplantación/métodos , Adulto , Angiografía , Estudios de Seguimiento , Humanos , Masculino , Erección Peniana/fisiología , Pene/irrigación sanguínea
20.
Swiss Surg ; 8(4): 197-9, 2002.
Artículo en Alemán | MEDLINE | ID: mdl-12227115

RESUMEN

Pseudarthrosis in the hand are defined as a non-union of a fracture after 6 month. Reasons might be biological disorders, mechanical instability or infection after fracture treatment. Pseudoarthrotic bone demands stable osteosynthesis and often bone grafting. The presented case is about a dislocated osseous fragment attached to the Aponeurosis dorsalis mimicking clinical and radiological a Pseudarthrosis of the proximal phalanx of the thumb. We would like to draw attention that osseous fragments may present very similarly to a pseudoarthrosis of a phalanx.


Asunto(s)
Fijación Interna de Fracturas , Fracturas Conminutas/cirugía , Fracturas Abiertas/cirugía , Cuerpos Libres Articulares/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Seudoartrosis/diagnóstico por imagen , Pulgar/lesiones , Adulto , Diagnóstico Diferencial , Fracturas Conminutas/diagnóstico por imagen , Fracturas Abiertas/diagnóstico por imagen , Humanos , Cuerpos Libres Articulares/cirugía , Masculino , Complicaciones Posoperatorias/cirugía , Seudoartrosis/cirugía , Radiografía , Reoperación , Pulgar/diagnóstico por imagen , Pulgar/cirugía
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