Ten-year long-term results of total joint arthroplasties with ARPE® implant in the treatment of trapeziometacarpal osteoarthritis

Producción CientíficaBetween May 1999 and April 2002 a total of 69 consecutive thumb carpometacarpal joint arthoplasties were performed in a total of 64 patients for carpometacarpal joint osteoarthritis using the cementless hydroxyapatite (HA)-coated unconstrained ARPE implant. Clinical, functional and radiological results at 10-year follow-up are presented. Survival analysis was performed using the Kaplan–Meier method. Of the 64 patients, fourwere lost to follow-up, 60 implants (92.3%) were functional and five (7.7%) were not (two dislocated, two were removed and one with aseptic loosening). Survival estimate for functional implants over 10 years was 93.9%(95% confidence interval 82.3–97.9). The radiographs were satisfactory in 82.4%. There was subsidence of thecup in 15.8%. Thumb carpometacarpal joint arthroplasty with the ARPE implant offers a reliable treatmentalternative in patients with Eaton grade III or IV thumb carpometacarpal joint arthritis in the presence of good bone stock

The long-term post-operative electromyographic evaluation of patients who have undergone carpal tunnel decompression

Producción CientíficaWe present the electromyographic (EMG) results ten years after open decompression of the median nerve at the wrist and compare them with the clinical and functional outcomes as judged by Levine's Questionnaire. This retrospective study evaluated 115 patients who had undergone carpal tunnel decompression at a mean of 10.47 years (9.24 to 11.36) previously. A positive EMG diagnosis was found in 77 patients (67%), including those who were asymptomatic at ten years. It is necessary to include both clinical and functional results as well as electromyographic testing in the long-term evaluation of patients who have undergone carpal tunnel decompression particularly in those in whom revision surgery is being considered. In doubtful cases or when there are differing outcomes, self-administered scales such as Levine's Questionnaire should prevail over EMG results when deciding on the need for revision surgery

The simonetta technique for carpal tunnel syndrome: Immediate postoperative evaluation and long-term comparative study

Producción CientíficaAim: Carpal tunnel release by opening the flexor retinaculum is considered a satisfactory treatment. However, in some patients, all the symptoms are not resolved. The objective of our study is to compare two surgical techniques. Material and methods: We have carried out a clinical, electromyographic and dynamometric evaluation of more than a hundred patients that received surgical treatment for Carpal Tunnel Syndrome, in a comparative analysis of the techniques used four weeks and ten years after surgery. Transverse ligament lengthening according to the Simonetta technique and mini-open decompression of the median nerve with an entire section of transverse ligament were compared. Results: The Simonetta technique, in the immediate postoperative period as well as ten years after surgery, contributes to better results of manual function and grip strength, with a higher presence of numbness and tingling than decompression with complete section of the flexor retinaculum. Conclusion: The technique of Simonetta is a surgical option to be considered in those patients affected by a mild to moderate carpal tunnel syndrome than require manual effort for daily activities

Resultados del tratamiento quirúrgico de la seudoartrosis de escafoides carpiano con la técnica de Fisk-Fernández

Producción CientíficaValorar los resultados clínicos y radiológicos obtenidos en el tratamiento de la seudoartrosisde escafoides del carpo inestable en los pacientes tratados en el Hospital ClínicoUniversitario de Valladolid con la técnica de Fisk Fernández. Material y método: Revisión de 43 casos de seudoartrosis intervenidos quirúrgicamente mediante técnica de Fisk Fernández, con un seguimiento mínimo de 6 meses, en la que se han valorado el tiempo hasta la intervención quirúrgica, el tratamiento previo, el mecanismo de lesión, tipo de seudoartrosis y la existencia de artrosis radio-carpiana. Hemos realizado una evaluación subjetiva utilizando el cuestionario Scaphoid Score y el DASHy una valoración objetiva mediante la escala modificada de Green & O Brien, junto con la medidade los ángulos intraescafoideos, radiolunar, escafolunar y la altura del carpo. Resultados: En nuestra serie el tiempo medio hasta consolidación fue entre 16-24 semanas, excepto en 3 pacientes que no consolidaron y precisaron cirugías de rescate. La variación entre los ángulos y la altura pre y postoperatorios del carpo medidos en las radiografías muestra que esta diferencia ha sido estadísticamente significativa. Discusión: Existen diferentes técnicas y materiales de osteosíntesis para el tratamiento de la seudoartrosis. La evaluación de resultados se realiza con escalas objetivas y subjetivas mostrando resultados variables entre estudios. Las diferentes técnicas van encaminadas a evitar la progresión de la enfermedad. Conclusión: La técnica de Fisk Fernández permite la corrección de la deformidad del escafoides,mediante injerto en cu˜na y la osteosíntesis con agujas de Kirschner o tornillos

Radial tunnel syndrome: results of surgical decompression by a postero-lateral approach

Producción CientíficaPurpose Our purpose is to describe the results obtained in surgical treatment of a series of patients with symptoms of radial tunnel syndrome. Methods We performed a prospective study on 42 patients (43 limbs) operated for radial tunnel syndrome between 1996 and 2010, using a posterior-external approach. Results Using the Roles and Maudsley criteria, 21 patients had excellent results (48.8%), 16 good (37.2%) and six fair results (13.9%). Most patients were satisfied with the surgery, reporting symptom relief and improved functionality. Conclusions Radial tunnel syndrome consists of intermittent compression of the posterior interosseous nerve in the forearm, with pain and functional disability of the forearm, without motor or sensory electromyogram alterations. Because it is often confused with enthesitis of the epicondyle muscle insertions (an entity often occurring simultaneously), differential diagnosis is necessary with treatment-resistant epicondylitis. The most effective treatment is surgical, releasing all possible nerve compression sites

Quadrilateral plate fractures of the acetabulum: An update

Producción CientíficaAcetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century

Referencias anatómicas para la tenolisis percutánea de los flexores de la mano

Producción CientíficaResumen: Objetivos: La tenosinovitis estenosante de los flexores de la mano es una patología muy frecuente en el ámbito laboral. Se han descrito distintos tratamientos de tipo conservador, aunque el tratamiento definitivo de los casos que no responden a otros tratamientos es quirúrgico, siendo la técnica abierta y la liberación percutánea las dos técnicas de elección. Esta última ha obtenido resultados superiores de satisfacción aunque la ausencia de visualización incrementa las lesiones neurovasculares y el riesgo de apertura incompleta de la polea, por ello es necesario establecer puntos de referencia anatómicos para realizar una correcta liberación. Material y método: Se realizó un estudio experimental en cinco manos de cadáver en el Departamento de Anatomía de la Universidad de Valladolid. Se realizaron mediciones de las longitudes de los dedos y de la polea. Se registró la posición de la aguja y de cada uno de los dedos al realizar la polectomía percutánea y se comprobó si la sección de la polea A1 fue completa, si existió alguna laceración de los tendones o si se produjo una lesión iatrógena del paquete neurovascular o de la polea A2. Resultados: Para establecer el punto de entrada de la aguja intramuscular se tomó como referencia la intersección entre el eje del dedo y el surco dígito-palmar. En el caso del tercer y cuarto dedo la entrada fue en el punto de la intersección, mientras que en el resto se desplazó 1-1,5 mm en dirección medial. El ángulo de entrada de la aguja intramuscular en el plano anterior osciló entre 0-30 grados en función del dígito, mientras que en el plano lateral fue siempre 0 excepto en el cuarto dedo que corresponde a un valor de -60 grados respecto al eje palmar. No se observó ninguna lesión iatrógena de los tendones flexores, del paquete neurovascular o de la polea A2. La apertura fue completa en todos los dedos salvo en un caso del segundo dedo. Conclusión: La tenolisis percutánea de la polea A1 es una alternativa a la liberación abierta tradicional, aunque existe controversia debido a la relación riesgo-beneficio. El conocimiento de las referencias anatómicas así como la posición exacta del dígito y de los instrumentos utilizados ayudan a evitar la liberación incompleta de la polea, los problemas neurovasculares y la lesión de estructuras adyacente. En el presente estudio anatómico se ha comprobado que es una técnica segura ya que no ha ocurrido ninguna lesión iatrógena y fiable, que se ha conseguido una liberación completa en todos los casos salvo uno

Ambulatory surgery in orthopedics: experience of over 10,000 patients

PurposeThe concept of day surgery is becoming an increasingly important part of elective surgery worldwide. Relentless pressure to cut costs may constrain clinical judgment regarding the most appropriate location for a patient’s surgical care. The aim of this study was to determine clinical and quality indicators relating to our experience in orthopedic day durgery, mainly in relation to unplanned overnight admission and readmission rates. Additionally, we focused on describing the main characteristics of the patients that experienced complications, and compared the patient satisfaction rates following ambulatory and non-ambulatory procedures.MethodsWe evaluated 10,032 patients who underwent surgical orthopedic procedures according to the protocols of our Ambulatory Surgery Unit. All complications that occurred were noted. A quality-of-life assessment (SF-36 test) was carried out both pre- and postoperatively. Ambulatory substitution rates and quality indicators for orthopedic procedures were also determined.ResultsThe major complication rate was minimal, with no mortal cases, and there was a high rate of ambulatory substitution for the procedures studied. Outcomes of the SF-36 questionnaire showed significant improvement postoperatively. An unplanned overnight admission rate of 0.14 % was achieved.ConclusionsOur institution has shown that it is possible to provide good-quality ambulatory orthopedic surgery. There still appears to be the potential to increase the proportion of these procedures. Surgeons and anesthesiologists must strongly adhere to strict patient selection criteria for ambulatory orthopedic surgery in order to reduce complications in the immediate postoperative term

Long-term results of the retrocapital metatarsal percutaneous osteotomy for hallux valgus

Producción CientíficaThe current trend in hallux valgus surgery is directed toward percutaneous procedures. However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone a percutaneous distal retrocapital osteotomy of the first metatarsal, and had been followed up for ten years. METHODS: We carried out a clinical and radiological evaluation of 115 feet ten years after surgery. RESULTS: The AOFAS scale results in the tenth postoperative year remained significantly favourable compared to their corresponding values in the preoperative period, yielding an improvement of 42.2 points overall on average. In relation to radiological findings, the mean hallux angle was maintained below 20 °, with a mean intermetatarsal angle of 8.1 °. CONCLUSION: Percutaneous retrocapital metatarsal osteotomy for treatment of mild to moderate hallux valgus is effective in the long term, with the advantages of a minimally invasive procedure

Long-term results of joint arthroplasty with total prosthesis for trapeziometacarpal osteoarthritis in patients over 65 years of age

Producción CientíficaTrapeziometacarpal osteoarthritis (TMCOA) is a highly prevalent disease in the older population. Many different types of surgical treatments are possible, depending on the degree of joint involvement, the personal and professional circumstances of the patient and the preferences of the orthopedic surgeon. This paper evaluated the clinical and radiological results of consecutive cohorts of patients over 65 years old treated with total joint arthroplasties (TJA) of the ball and socket type (B&S) for TMCOA, with a minimum of 10 years follow-up. The survival rate (Kaplan–Meier) of the functional prostheses at 10 years was 92.2% (95% CI (89.1%, 96.1%). These functional arthroplasty patients, after 10 years of follow-up, showed little or no pain, good function and good key pinch, without radiological alterations. TJAs of the B&S type are a long lasting, effective and reliable alternative to surgical treatment of TMCOA in patients over 65 years of age, when they are performed with the patient selection criteria and surgical technique described throughout this study.Fundación General de la Universidad de Valladolid (FUNGE-Uva) - (Art. 83 number 061/186301