RESUMO
Background: The one-bone forearm procedure has been considered as a potential treatment for severe forearm deformities. However, its primary limitation lies in the elevated risks of nonunion and infection. In order to enhance union rates, a technical modification was introduced, aiming not only to establish end-to-end radio-ulnar fixation but also to incorporate an additional overlay and fixation between the proximal and distal radius osteotomy stumps. This technique, initially applied in a heterogeneous patient population including individuals with neurological, tumoral, and congenital conditions, yielded promising results, achieving a consolidation rate of 100% and enabling supination corrections of up to 120°. Methods: In this study, we present a retrospective cohort of 28 patients, with an average age of 9 years, all afflicted by forearm supination contracture exceeding 90° secondary to neonatal brachial plexus injury. These patients underwent treatment with the modified technique. Results: The mean correction achieved in forearm rotation was 116°, and the average follow-up period extended to 43 months. Remarkably, all patients exhibited bone union within an average period of 6.6 weeks, without any complications. Conclusion: Our findings underscore the efficacy of this modified technique, which enables substantial rotational corrections, boasts a high union rate, and maintains a low incidence of complications. This approach is particularly valuable for young patients suffering from neonatal brachial plexus injury with severe fixed supination deformities. Case series Level of evidence: IV.
RESUMO
Congenital pseudarthrosis of the forearm poses a considerable challenge because of its rarity. The objective of this report is to introduce a novel surgical technique for its treatment. Here, we document a case of congenital pseudarthrosis of the radius in a 3-year-old boy diagnosed with type-1 neurofibromatosis. The surgical treatment involved the excision of approximately 9 cm of native radial periosteum and a bifocal radius osteotomy, which was supplemented with a vascularized tibial periosteal transplant to facilitate bone healing. Anastomosis between the anterior tibial vessels and radial vessels was performed. No immediate or late postoperative complications were observed. After 3 weeks, a robust callus formation was observed, and during a follow-up examination 3 years and 4 months later, a wide range of active forearm rotation was noted. This report suggests that vascularized periosteal flaps show promise as a viable treatment option for congenital pseudarthrosis of the forearm. They offer an alternative to vascularized fibular grafts or single-bone forearm constructs.
Assuntos
Periósteo , Pseudoartrose , Tíbia , Humanos , Pseudoartrose/congênito , Pseudoartrose/cirurgia , Masculino , Pré-Escolar , Periósteo/transplante , Tíbia/cirurgia , Neurofibromatose 1/complicações , Neurofibromatose 1/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/transplante , Osteotomia/métodos , Rádio (Anatomia)/transplante , Rádio (Anatomia)/cirurgia , Rádio (Anatomia)/anormalidades , Transplante Ósseo/métodosRESUMO
Introducción El dolor del pulgar secundario a la artrosis de la articulación trapecio-metacarpiana es una condición común, especialmente en mujeres llegando a causar niveles altos de incapacidad en algunos pacientes. El diagnóstico de rizartrosis se basa en el dolor localizado, la inflamación e inestabilidad en la exploración física además de la valoración radiológica. Existen en la actualidad varias pruebas semiológicas que podemos utilizar en el diagnóstico de la rizartrosis sintomática, una de ellas es la prueba de Grind o molienda, que es considerada el patrón de oro. El presente estudio tiene como objetivo describir y evaluar la prueba de Compresión y flexión del pulgar ideada para el diagnóstico de rizartrosis. Materiales y Métodos Se realizó un estudio de corte transversal en el periodo de enero del 2007 a mayo del 2013, Se evaluaron 230 pacientes que acudieron a consulta con síntomas sugestivos de rizartrosis a quienes se les practico simultáneamente la prueba de Grind y la prueba de compresión y flexión para la confirmación del diagnóstico. Resultados De los 230 pacientes que acudieron a consulta, el 87.8% (202) eran mujeres con una edad promedio de 60 años (32 a 86 años). El 14.8% de los pacientes presentaron una afectación bilateral. El 47.8% tenían comorbilidades presentes entre las que se encuentran síndrome de túnel carpiano en el 67.3%, dedo en gatillo 11.8%, entre otras. El índice de concordancia PABAK entre los dos signos semiológicos fue de 0.948, indicando un nivel de acuerdo excelente entre ambos. El 100% de los pacientes fueron diagnosticados por la prueba de flexión y compresión. Discusión producto de obtener una prueba positiva en la totalidad de los pacientes evaluados con la prueba de compresión y flexión, consideramos puede ser una opción que complemente la pesquisa clínica en el paciente con rizartrosis, es necesario entonces estudios posteriores para validar dicha prueba y poder obtener su sensibilidad y especificidad.
Background Thumb pain secondary to osteoarthritis of the trapezium-metacarpal joint is a common condition, especially in women, and causing high levels of disability in some patients. The diagnosis of rhizarthrosis is based on localised pain, inflammation, and instability on physical examination, in addition to radiographic evaluation. There are currently several semiological tests that can be used in the diagnosis of symptomatic rhizarthrosis, one of which is the Grind or grinding test, which is considered the gold standard. The present study aims to describe and evaluate the thumb compression and flexion test designed for the diagnosis of rhizarthrosis. Methods A cross-sectional study was carried out during the period from January 2007 to May 2013. The study included a total of 230 patients that came to the clinic with symptoms suggestive of rhizarthrosis, and on whom the Grind test, the compression test, and flexion were simultaneously performed to confirm the diagnosis. Results Of the 230 patients who attended the clinic, 87.8% (202) were women with a mean age of 60 years (32 to 86 years). A bilateral involvement was observed in 14.8% of the patients. Just under half (47.8%) currently had co-morbidities that included, among others, carpal tunnel syndrome (67.3%) and trigger finger (11.8%). The prevalence-adjusted and bias-adjusted kappa (PABAK) concordance index between the two semiological signs was 0.948, indicating an excellent level of agreement between both. All (100%) of the patients were diagnosed by the flexion and compression test. Discussion Due to obtaining a positive test in all the patients evaluated with the compression and flexion test, it should be considered as a complementary test in the clinical evaluation of patients with rhizarthrosis. Further studies are necessary to validate this test in order to establish its sensitivity and specificity.
Assuntos
Humanos , Polegar , Testes Diagnósticos de RotinaRESUMO
Introducción: El síndrome de túnel del carpo afecta el 1% de la población, siendo la neuropatía por compresión más frecuente, la liberación endoscópica es una técnica que presenta buenos resultados, aunque no está exenta de complicaciones. Objetivo: El objetivo del estudio es determinar la prevalencia de complicaciones asociadas en una experiencia de 5 años. Metodología: Estudio de corte transversal en pacientes con diagnóstico del túnel del carpo sometidos a liberación endoscópica en un periodo de 5 años, donde se documentó todas las complicaciones neurológicas, vasculares e infección. Resultados: Se incluyeron 175 manos en 139 pacientes con un promedio de edad de 52 años de edad; el 89.2% de los casos se presentaron en mujeres. Las comorbilidades encontradas fueron: hipertensión arterial 31.6%, hipotiroidismo 29.5%, diabetes 5%, y consumo de cigarrillo 11%. La prevalencia de complicaciones fue del 5.7% (10 casos), de las cuales la lesión neurológica fue del 0.6% clasificada como neuropraxia del nervio cubital, 1.7% presentaron hematomas que resolvieron sin cirugía y 3.4% presentaron infección que resolvieron con manejo antibiótico y curaciones. Todas las complicaciones presentaron una recuperación satisfactoria. El 99% de los pacientes presentaron resolución de los síntomas. Conclusiones: La técnica de liberación endoscópica del túnel del carpo es una técnica segura, en donde se encontró un porcentaje bajo de complicaciones siendo comparables a otras series.
Introduction: The carpal tunnel syndrome affects 1% of the population, remain the most common compression neuropathy, endoscopic release is a technique that gives good results, although not without complications. The aim of the study is to determine the prevalence of complications in an experience of 5 years. Methodology: Cross-sectional study in patients diagnosed with carpal tunnel undergoing endoscopic release over a period of 5 years, where all neurological, vascular complications and infection was documented. Results: We included 175 hands in 139 patients with an average age of 52 years; 89.2% of cases occurred in women. Comorbidities found: hypertension 31.6%, 29.5% hypothyroidism, diabetes 5% and 11% cigarette consumption. The prevalence of complications was 5.7% (10 cases), of which the neurologic injury was 0.6% classified as neuropraxia of the ulnar nerve, 1.7% had hematoma that resolved without surgery and 3.4% had infection threated with oral antibiotics. All complications had a satisfactory recovery. 99% of patients experienced resolution of symptoms. Conclusions: The technique of endoscopic carpal tunnel release is a safe technique, low complication rate was found and is comparable to other series.