Arthrolysis in the relief of post-traumatic stiffness of the elbow

A retrospective clinical study of 34 patients treated by arthrolysis for elbow stiffness is presented. These patients had sustained previous injury which was a simple fracture in 44%. The average age at operation was 31 years with a range from 6 to 57 years. Follow up for a minimum of one year, and an average of four years, showed an increase of motion from a preoperative average of 45 degrees to a postoperative average of 92 degrees with few complications and only three unsatisfactory results. This analysis has allowed conclusions concerning the technique and indications for operation

Artroplastia "De la Caffinière" en pacientes afectos de artrosis trapecio-metacarpiana: seguimiento a 15 años

Presentamos un estudio descriptivo retrospectivo de 13 pacientes afectos de artrosis-trapecio metacarpiana intervenidos con artroplastia De la Caffinière en el departamento de Cirugía Ortopédica y Traumatología de la Clínica Universitaria de Navarra con un seguimiento medio de 14,2 años. La edad media de los pacientes fue de 56 años (rango 30 a 76 años). En 12 casos fueron mujeres y en una ocasión un varón. Los resultados funcionales son excelentes. Las complicaciones observadas durante el seguimiento ha sido el aflojamiento del componente trapecial (15-25%). La artroplastia De la Caffinière como tratamiento de la artrosis trapecio-metacarpiana muestra resultados excelentes en pacientes de 60 años con baja demanda funcional y un estadio III de Eaton en la articulación trapeciometacarpiana. Las movilizaciones asépticas observada en nuestro estudio son asintomáticas y no requirieron tratamiento médico o quirúrgico siendo bien tolerada por los pacientes.We report a descriptive retrospective study of 13 De la Caffinière trapezium-metacarpal cemented protheses implanted for painful TMC arthrosis in the Department of Orthopedics of the University Clinic of Navarra with an average follow-up of 14,2 years. The middle ages of the patients were 56 years old (range 30 to 76 years). In 12 cases they were women and in one case a male. The functional results are excellent. The complications observed during the follow-up has been the loosening of the trapezium component (15-25 %). De la Caffinière arthroplasty as treatment of the degenerative TMC arthrosis shows excellent results in 60-year-old patients with low functional demand and a stadium III of Eaton. The aseptic mobilization observed in our study are asymtomatic and they did not need medical or surgical treatment being well tolerated by the patients

Resección de la primera fila del carpo: indicaciones y resultados

La resección de la primera fila del carpo (RPC) es un conocido procedimiento para conservar la función en muñecas afectadas por procesos degenerativos de la articulación radiocarpiana. En el presente trabajo nuestra experiencia con este tipo de intervención. Material y Métodos: Análisis retrospectivo de pacientes intervenidos en nuestro centro mediante RPC. Se valoraron: datos demográficos, dolor, movilidad y fuerza, y evolución radiológica tras la cirugía. Resultados: 1 pacientes de edad media 58 años, con seguimiento medio de 16 meses. Tras la RPC se observó mejoría del arco de movilidad de la muñeca y de la fuerza de prensión. Cuatro pacientes no tenían dolor. Seis pacientes pudieron reincorporarse a su trabajo. Un paciente evolucionó con rigidez y artrosis radio-hueso grande, que precisó artrodesis al año y medio de la cirugía. Conclusiones: La PRC es una buena intervención para el tratamiento de la artrosis evolucionada de la muñeca.Proximal Row Carpectomy (PRC) is a recognised procedure to preserve motion for wrists which are affected by degenerative diseases at the radiocarpal joint. Material and Methods: Retrospective review of patients subjected to a PRC in our Institution. Demographic data, pain, mobility and grip force, and radiologic evolution before and after surgery were determined. Results: Seven patients, with an average age of 58 years-old. Average follow-up of 16 months. After PRC there was an improvement of mobility and grip force. Four of the seven patients were pain-free. Six patients were able to return to work. One patient developed arthritis of the wrist, being subjected to a wrist arthrodesis one year after surgery. Results: PRC is a good intervention for advanced arthritis of the radiocarpal joint

Extradigital glomus tumour causing thigh pain: a case report

Glomus tumours are rare and benign, arising from a neuromyoarterial glomus body, most commonly in the hand. We report a patient with such a tumour in an atypical site, the right vastus lateralis. Pain was aggravated by muscle contraction, and ultrasonography and MRI were required to locate the lesion accurately. Surgical excision gave immediate pain relief

Radial shortening for the treatment of Kienböck's disease

Twelve patients with Kienbock's disease were treated by radial shortening. Eight patients were in stage II and four in stage III. After an average of 5 years, relief of pain was satisfactory in 10 patients; 8 were in stage II before operation and 2 in stage III. Two patients were dissatisfied because they had persistent pain; both were in stage III before surgery. The range of motion improved moderately. Nonunion at the site of radial osteotomy did not occur. Radiographs at follow up showed consolidation and healing of the lunate in 2 patients, nonprogression of the disease in 9 and increase of the carpal collapse in 1. The procedure helps to prevent further collapse of the lunate especially in stage II and in some patients in stage III

Fracturas de antebrazo: resultado funcional tras reducción abierta y osteosíntesis

Hemos realizado una revisión retrospectiva de pacientes intervenidos por fracturas de antebrazo, recogiendo el resultado funcional (Grace-Eversmann). También hemos analizado la deformidad radial residual mediante el cálculo curvatura mayor del radio (CMR). Se cálculo el coeficiente de correlación de Pearson entre la CMR y el resultado funcional. Los resultados de 20 pacientes intervenidos entre 1972 y 2005. El tratamiento quirúrgico fue de reducción abierta y fijación interna (RAFI) en el 70%. El resultado funcional fue de excelente el 50% y malo en el 20%. La curvatura mayor del radio oscilaba entre 5 mm - 20 mm. No hemos observado correlación entre las variables estudiadas. No hemos observado correlación anatómico-funcional en los pacientes tratados quirúrgicamente por fractura de cubito y radio.Retrospective review of clinical notes. Data regarding to the surgical treatments. Functional outcomes (Grace-Eversmann). Residual radius deformity was analyzed measuring the radius curvature. Pearson's correlation coefficient was measured between radius curvature and functional outcome. Data of 20 patients attended between 1972 and 2005 are reviewed. Surgical treatment was open reduction and internal fíxation in 70% patients. The outcome was excellent in 50 % and poor in 20%. La major curve of the radius was between 5mm -20 mm. We haven't seen correlation in the variables studied. We haven't seen between the curvature of the radius and functional outcome any correlation in patients treated surgically of ulna and radius fractures

Catastrophic wear in a metal-on-ceramic total hip arthroplasty

A 51-year-old woman came to our clinic 6 months after a right total hip arthroplasty. She had noticed a slowly growing mass in the proximal thigh and referred progressive pain in the right groin. Plain radiography revealed premature acetabular cup aseptic loosening, and in the computed tomography study, a 14-cm-diameter mass was observed. Revision surgery was performed, showing a metal-on-ceramic bearing surface. The histologic analysis of surrounding tissues was reported as massive metallosis. Although occasionally chosen for primary or revision hip arthroplasty, there is little information available about the in vivo wear behavior of this combination. This important fact should be taken into account before considering such a surface alternativ

Reconstrucción del extremo distal de radio mediante aloinjerto osteoarticular contralateral después de la resección de un tumor esquelético

La reconstrucción radio distal tras la resección de tumores en esa localización, constituye un desafío para el cirujano ortopédico. Hemos modificado la técnica de reconstrucción utilizando el aloinjerto osteoarticular de radio distal contralateral y presentamos nuestra experiencia. El objetivo principal de esta modificación es evitar la inestabilidad estructural del aloinjerto de radio y mejorar su función. Estabilizamos el aloinjerto contralateral mediante una placa y tornillos sobre la superficie volar del radio. El complejo fibrocartilago triangular y los ligamentos palmares de la muñeca se suturan a los ligamentos correspondientes del aloinjerto. La articulación de la muñeca se fija con agujas de Kirschner durante 6 semanas. Se evaluaron cuatro pacientes con aloinjerto osteoarticular de radio distal contralateral con una edad media de 28 años (rango de 23 a 33) y con una media de seguimiento de 42 meses. Obtuvimos ausencia de recidivas locales y una correcta consolidación del aloinjerto en todos los casos. El rango de movilidad articular medio fue 36,3° flexión dorsal, 17,5° flexión volar, 10,7° abducción, 10° aducción, 62,5° pronación y 46,3° de supinación. La reconstrucción del radio distal con aloinjerto contralateral es una técnica útil para solucionar grandes defectos osteoarticulares y provee mayor estabilidad articular al cambiar la orientación de la carilla articular del radio.The reconstruction of the distal radius after excision of a skeletal tumor in this location is a challenge for the orthopedic surgeon. The objective of our modification is to prevent structural instability in the allograft and improve its function. We report our experience with the use of a contralateral osteoarticular allograft. The allograft was stabilized with a plate and screws above the volar surface of the radius. The palmar ligaments of the wrist and the fibrocartilage complex were sutured to the corresponding ligaments of the allograft. The wrist joint was fixed with a Kirschner wire for six weeks. We report 4 patients with a contralateral osteoar- ticular allograft. The average age was 28 years (range 23 to 33) and the average follow-up was 42 months. The average range of wrist motion was: dorsal flexion 36.3°; volar flexion 17.5°; abduction 10.7°; adduction 10°; supination 46.3° and pronation 62.5°. Correct union of the allografts and absence of local recurrence of the tumor was obtained in all patients. The reconstruction of the distal radius with a contralateral osteoarticular allograft is a useful technique for repairing large defects and greater joint stability is achieved by changing direction of the articular surface of the radius

Arthrodiastasis for stiff hips in young patients

Joint distraction (arthrodiastasis) with a unilateral fixator was used to treat 9 patients with stiffness of the hip which had followed Perthes' disease (3), epiphysiolysis (2), congenital dysplasia (2), tuberculosis (1) and idiopathic chondrolysis (1). Their average age was 14 years, and they all had pain, limp and shortening of the leg. Distraction of 0.5 to 1 cm was maintained for an average of 94 days. The average range of movement subsequently was 65 degrees compared with 20 degrees before. The articular space was widened by an average of 2.8 mm, and only 3 patients had pain on follow up

Resultados a largo plazo de la artroplastia total de la articulación trapeciometacarpiana mediante la prótesis cementada “de la Caffinière”

Presentamos una serie de 13 artroplastias con prótesis totales cementadas trapeciometacarpianas (TMC) "de la Caffinière" implantadas en nuestro departamento como tratamiento de la artrosis TMC dolorosa e inestable. De 11 pacientes, fueron 10 mujeres y un hombre. La media de edad fue de 65 años (mínima 50 y máxima 75). En 2 pacientes el implante fue bilateral y la media de seguimiento fue de 8 años. La media de movimiento articular del pulgar afecto con respecto al contralateral fue: abducción 38o/39o, flexión 7o/9o y ex- tensión 29o/31o. En un caso, la radiografía mostró un área radiolucente alrededor del componente trapecial sin repercusión clí- nica. El resultado subjetivo fue bueno en 9 pacientes y aceptable en 2. Los buenos resultados a largo plazo hacen de este procedimiento una opción válida en el tratamiento de la artrosis TMC dolorosa y con perdida funcional.Background: We report a series of 13 arthroplasties using De la Caffinière cemented trapezium-metacarpal prostheses which were implanted to treat unstable and painful TM arthrosis in our department. 10 patients were women and 1 was a man. Mean age, 65 years (range 50 to 75 years). 2 patients received bilateral implants. The mean follow-up was 8 years. The mean mobility of the operated side compared with the opposite thumb were: abduction 38o/39o, flexion 7o/9o y extension 29o/31o. The radiography showed in one case a radiolucent area around the trapezium component of the prosthesis with no clinical repercussion. The subjective results were good in 9 cases and acceptable in 2. The good long-term results of this procedure make it a valid alternative for the treatment of painful TMC arthrosis which limits normal function