Resumen Introducción La pseudoartrosis de escafoides con deformidad en joroba es una patología compleja que si no recibe tratamiento oportuno puede llevar a una deformidad avanzada, con colapso del carpo produciendo un deterioro significativo en la función de la muñeca. En la actualidad se considera como tratamiento estándar la reducción abierta de la deformidad utilizando injerto estructural.El objetivo del presente trabajo es describir una técnica de reducción artroscópica, utilizando injerto no estructural para la no-unión de escafoides con deformidad en joroba. Se muestran los resultados obtenidos en una serie de casos manejados con la técnica propuesta. Material y método Estudio retrospectivo de una serie de casos de pacientes diagnosticados con pseudoartrosis de escafoides con deformidad en joroba manejados con la técnica propuesta. Se describe la técnica quirúrgica. Se utiliza el programa STATA 15 para el análisis estadístico de los resultados, al igual que test de Wilcoxon para variables no paramétricas. Resultados Once pacientes de sexo masculino, con edad promedio de 23,4 años, completaron seguimiento promedio de 12 meses. En todos los pacientes se comprobó consolidación de la no-unión mediante Tomografía Computada en un tiempo promedio de 9,1 semanas. Todos los pacientes mejoraron sus rangos de movilidad y ángulos imagenológicos de manera significativa y mejoraron en la prueba funcional de DASH (p = 0.0033). Discusión Se muestra una técnica de reducción percutánea con asistencia artroscópica utilizando injerto no estructural para corregir la no-unión de escafoides con deformidad en joroba produciéndose buenos resultados clínicos con consolidación, en todos los pacientes de nuestra serie, similar a lo encontrado en la literatura internacional. Creemos que esa técnica permite una corrección parcial de la anatomía del carpo y favorece la consolidación ósea al tener las ventajas teóricas de una técnica mínimamente invasiva.
One of the most important causes of residual damage in skeleton is incompletely treated osteoarticular infections (OAI). Goal: to assess the value of emergency three-phase bone scan (3FBS) in the evaluation of OAI. Methods: Thirty-eight children were studied with 54 3FBS. Results: Global analysis: 76% of the cases were principally articular; staphylococcus germs and hip's affection were the common. Nine patients with preoperative scan were positive with 16 foci, 86% confirmed by surgery cultivate. Seven children had negative 3FBS without posterior clinical symptomatology; in 5 of them it was demonstrated soft tissue involvement with normal osteoblastic phase. In 14/17 cases evaluated after surgical intervention, there was a relation between the scan and the clinical course. In two of those cases, in the 3FBS a new location was found. Conclusion: 3FBS is a helpful tool in the diagnosis and assessment of acute OAI in pediatric population. A positive 3FBS is highly accurate for OAI and a negative one rules it out securely.
Distal Radius41S scan is considered to show more precisely the steps and rotational deviations of these fractures but is not routinely used for initial patient assessment. The objective of the present study was to determine whether CT scan is useful for planning and treating the fractures of the distal radius in adults showing the level of interobserver agreement for classifying and treating fractures, and whether CT scan changes the directions of the treatment previously indicated only with conventional radiography. Materials and Methods: Five observers with similar professional backgrounds in hand surgery evaluated the CT scans and radiographs of 36 patients with fractures of the distal radius that were distributed by a moderator in a blind form, by chance. These patients were accepted and included in the study in a trauma reference hospital in the 6-month period. A total of 180 CT scans and 180 x-rays were evaluated. Fractures were classified using the universal and Arbeitsgemeinschaft für Osteosynthesefragen (AO) methods by the observers who indicated, as well, one of the five treatments previously predetermined, evaluating randomly the x-rays and CT scans on both situations. Interobserver agreement was researched for each one of the classifications and for the indication of treatment with the use of CT scan and x-ray thereafter. Results: The Kappa evaluation showed the same range of agreement (0.20-0.39) on both examinations. There were fewer indications of nonsurgical treatment (23 indications with CT scan against 41 with the x-ray) and an increased number of indications of more complex forms of treatment when CT scan was analyzed. Conclusions: It is concluded that CT scan and radiography have similar levels of interobserver agreement for classification and indication of treatment of fractures of the distal end of the radius. CT scan showed to be a useful imaging method, besides the use of radiography, for initial evaluation and also for indication of the treatment of fractures of the distal end of the radius. CT changed this indication in a significant way when compared with x-ray. Although some studies recommend CT only for indicating the preferred treatment option after the surgical decision, our study demonstrated that tomography evaluation is important even before the indication of the treatment because it adds more information for classification, and therefore, to change treatment planning, which may be a great benefit to reduce the degenerative processes and other complications. Background:The volar locking plate (VLP) has been widely used over the past 2 decades in patients with distal radius fractures (DRFs). However, flexor pollicis longus (FPL) ruptures are a well-known postoperative complication of using the VLP system, although the incidence of tendon ruptures following VLP fixation remains unclear. The purpose of the present study was to assess the frequency of FPL rupture on a large scale in patients with DRFs who were treated with the VLP system. Materials and Methods: A questionnaire was ad...
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