La Revista Cirugía de mano y microcirugía, es una publicación científica de circulación semestral, digital y de acceso abierto; en la cual se publicarán artículos científicos de alta calidad, revisados por pares y con indexación internacional. La temática central son los temas de ciencias básicas, fisiopatología, diagnóstico y tratamiento de las patologías y condiciones de la mano, el miembro superior y la microcirugía. La revista trabajos originales e inéditos, que no hayan sido publicados parcial o totalmente (en formato impreso o electrónico), ni que estén sometidos a publicación en ningún otro medio. La aceptación o rechazo de un documento depende del proceso de evaluación por pares, la selección del material propuesto para publicación se basa en criterios como: idoneidad del tema para la revista, solidez científica, originalidad, actualidad y oportunidad de la información, aplicabilidad más allá del lugar de origen y en todo el ámbito regional, acatamiento de las normas de ética médica sobre la experimentación con seres humanos y animales, variedad de los temas y coherencia metodológica del estudio.
Asociación Colombiana de Cirugía de la Mano
El mundo de la cirugía de mano unido desde el centro del planeta
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Adult Brachial Plexus Injuries: Treatment in the Acute Phase
Brachial Plexus Injuries are a catastrophic situation that affects patients on many levels. While many treatment options are discussed in the literature, general treatment principles should be applied, especially in the acute phase. In addition to the surgeon's expert knowledge of anatomy and injury characteristics, education of the patient concerning the ramifications of their injury and providing clear expectations of realistic outcomes are imperative for both the surgeon and the patient. A review of the principles of acute surgical treatment will be presented.
Abstract: The compression of the median nerve and the ganglion are the most common compressive neuropathy of the peripheral nerve of the upper extremity and the most frequent tumor in the hand respectively, the presence of a ganglion can trigger compression of the median nerve, entity of varied etiology and whose management depends of the severity of the compression and associated etiology. Methodology: Clinical case report: median nerve compression by volar carpal ganglion, literature analysis and surgical technique Results: Functional scales were used: DASH score measured at 1, 3, 6 and 12 months and pain assessment by VAS, having at the end of follow-up a DASH score of 15 with VAS of 0, with mild disability in strength activities but with return to the work and daily activity, adequate gripping strength and range of motion, without alteration in relation to the contralateral hand. Patient with immediate relief of symptoms after surgery with improvement in functional scale at one year of follow-up and without recurrence. Conclusion: In cases of compression of the median nerve secondary to an intratunnel space-occupying mass, as is the case of a ganglion, the release is performed by resection of the occupying mass, arthroscopy is a great option as it is a minimally invasive technique with excellent results by allowing direct visualization of the mass and confirmation of its total resection. Key words: Compressive neuropathy, carpal tunnel syndrome, ganglion cyst, arthroscopy
Distal radius fracture. What we do not see with conventional approach? The role of arthroscopy.
Introduction: Distal radius fractures (DRFs) are very common and they can frequently be associated with cartilage or ligament injuries. The purpose of this study is to identify and evaluate the incidence of associated injuries in intra-articular DRFs diagnosed by wrist arthroscopy. Methods: This is a descriptive epidemiological study done on patients with intra-articular DRFs treated with open reduction and internal fixation (ORIF) with a volar locking plate assisted by wrist arthroscopy. Patients were included from January 2017 to December 2021 according to the Excel surgical database of Elbow and Hand Unit of Hospital. Patients with different lesions of DRFs, intra-articular fractures without arthroscopy assistance and extra-articular fractures were excluded. Results: We identified 148 patients (81 men and 67 women) with an average age of 47 years (16-82). Concomitant lesions were observed in 99 patients (66%). The most frequent one is TFCC injury in 70 patients (47%). We observed lesions of an interosseous ligament in 62 patients (42%), 51 of scapholunate (SL) ligament and 37 of lunotriquetral (LT) ligament. Isolated injury of a structure was identified in 15 patients (10%) and both of them in 14 cases (9%). These lesions were treated in the arthroscopy procedure when that was indicated. Conclusions: concomitant lesions were found in most of patients with intra-articular DRFs. The first one is TFCC injury, followed by intrinsic midcarpal ligament lesions. Wrist arthroscopy is necessary method to evaluate and treat associated lesions of TFCC and intrinsic ligaments. Level of evidence: IV
Application of the “WALANT” technique in commonly used local flap surgeries for hand and finger coverage
Introduction. Different benefits have been demonstrated with the application of the WALANT technique in the field of upper limb surgery, highlighting its simplicity, good results and reduction in the costs of surgical treatment. Many upper limb surgical procedures are performed daily with the use of Lidocaine / Epinephrine anesthesia. These procedures include coverage of skin defects. However, this anesthetic technique has not been widely reported in this field. The objective of this study is to report our experience in the realization and transfer of common flaps for the coverage of fingers and hands with the use of t he WALANT technique. Methods. Prospective, descriptive and follow-up study of a series of nine patients submitted to different types of local flaps for hand and finger coverage with the WALANT technique. Results. All patients underwent surgery without the use of a tourniquet. The average pain during anesthesia, surgery and postoperative (E.V.A.) was 1.3. All flaps healed without complications. The final functional result was Excellent in all patients in the study. Conclusion. The WALANT technique in local flap surgery for the hand and fingers applied in our study group, proved to be safe, reproducible, painless, effective, low cost and well accepted by the patient.
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Hoy quiero rendir un homenaje a mi hermano del alma, a nuestro querido Félix Riaño Plazas, quien murió de manera súbita, precoz e inesperada el pasado 21 de mayo de 2023 en la ciudad de Bogotá (Colombia), dejando un vacío irreparable en su madre Concepción Plazas; su esposa Janeth Riaño; sus hijos Juan Camilo, Sebastián, Sofia, Gabriel y Paula, así como en mí y mi familia. Félix fue un ser humano muy especial, incondicional en todas sus facetas, quien siempre se caracterizó por una alegría que nos irradiaba a todos los que lo rodeamos, por una energía inagotable, por una actitud optimista hacia todo y por un carisma cargado de sentido del humor con el que era capaz alegrarnos y de hacernos reír, pues siempre tenía un chiste para cualquier situación y para todo escenario de nuestras vidas. Sus condiciones intelectuales le permitieron ingresar a la Escuela Militar de Medicina y Ciencias de la Salud de Bogotá en 1981, donde iniciamos nuestra carrera de medicina y nuestra hermandad eterna. En 1986 se graduó como médico e ingresó a la Fuerza Aérea Colombiana como oficial desempeñando varios cargos a lo largo del país. En 1991 inició su residencia en ortopedia y traumatología en el Hospital Militar Central, especialidad de la cual posteriormente fue nombrado como instructor en esa misma institución. En 2001 viajó a Estados Unidos y se radicó en Pittsburgh, Pennsylvania, en donde ingresó al Allegheny General Hospital para realizar su especialización en cirugía de la mano y miembro superior. Posteriormente se trasladó a Miami, Florida, en donde durante varios años ejerció la parte clínica de su profesión y su constante interés en la investigación le permitió realizar y publicar estudios que se convirtieron en referentes en la especialidad a nivel mundial. Félix fue miembro activo de la la American Society for Surgery of the Hand y la American Academy of Orthopaedic Surgeons, y en 2007 se vinculó como clinical specialist, medical ducation-medical affairs, manager, medical education-medical affairs y senior manager, medical education- medical affairs en Arthrex; allí se desempeñó por más de 14 años y, gracias a su capacidad de trabajo y experiencia educativa, organizó y creo los programas de educación para cirujanos ortopedistas y cirujanos de la mano, en los cuales combinó las técnicas abiertas y artroscópicas, reconocidas en todo el mundo como fundamentales en la formación profesional de estos especiallistas. En septiembre de 2022 Félix inició su último reto profesional como medical director, medical safety & science en KARL STORZ, pero es importante aclarar que a pesar de que trabajó tanto años fuera de su país natal, nunca se alejó del todo de Colombia y siempre fue miembro activo de la Sociedad Colombiana de Ortopedia y Traumatología, y de la Asociación Colombiana de Cirugía de la Mano, en donde participó interrumpidamente presentando trabajos de investigación y asistiendo sin falta a todos los congresos anuales. De Félix nos queda por siempre su esencia y su legado; además, gracias a su invaluable aporte a la sociedad, su imagen perdurará en el tiempo y todos los que tuvimos el honor y la bendición de conocerlo guardaremos su mejor imagen, honraremos su memoria y sembraremos una semilla para que su recuerdo perdure. Querido Félix, hermano mío, vuela alto y descansa en paz.
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Trans-Scaphoid Perilunate Fracture Dislocation. Case series
The carpal joint is biomechanically one of the most complex; this is composed of several osteoligamen- tous structures responsible for its stability and whose alteration can generate pure ligamentous carpal instability or in association with bone injury;in the spectrum of these injuries we can nd the trans- scaphoperilunate fracture dislocation (TEPLFD), a potentially devastating injury. An early diagnosis and adequate treatment are crucial for a better prognosis. Objective: Review the current literature on traumatic TEPLFD, presenting a series of cases and the authors’ experience in its management. Methodology: Between 2019 and 2022, 6 patients with di erent types of TEPLFD were evaluated ret- rospectively, their medical histories and surgical protocols were analyzed, with follow-up at 24 months. Results: 100% male, mean age 22 to 28 years, history of motorcycle accident, 5 acute injuries and one chronic; average follow-up: 24 months; functional results: exion 58° (52° to 75°), extension 56° (45° to 70°), pronation 65° (60° to 70°), supination 60° (55° to 70°). Functional scales: DASH 12 months: 16.75 points (range 7.5 to 27.5), PRWE 12 months: 18.42 points (range 15 to 22), average VAS of 2 points that translates into mild pain. Conclusion: TEPLFD are rare and potentially devastating lesions, requiring high diagnostic suspicion. These injuries must be treated early allowing optimal bone reduction and ligament repair.
Intravascular papillary endothelial hyperplasia of a finger
We report a case of an intravascular papillary endothelial hyperplasia, or Masson’s tumor, a rare benign vascular tumor, located at the volar side of the distal phalanx of the thumb of a 60-year-old man. The diagnosis was made after the histological study because the magnetic resonance imaging studies were inconclusive. While the prognosis is excellent, differentiation from other causes that require more extensive in terventions is essential.
Arthroscopic Radiocarpal Interposition Arthroplasty with Brachioradialis
Introduction: Wrist osteoarthritis is a highly frequent pathology, which involves multiple symptoms that lead to absenteeism from work and progressive functional alterations. Currently, there are ample treatment options, mainly surgical, some of them with secondary loss of strength and range of motion. This is why we present an innovative surgical technique that could serve as a reproducible and viable option in patients with this type of pathology. Materials and methods: A technique for arthroscopic radiocarpal interposition arthroplasty is described, using a brachioradialis tendon flap as a substrate, for patients with wrist osteoarthritis due to multiple causes; The findings of the short-term follow-up of two patients operated on with this technique are presented. Discussion: In the current literature there are multiple techniques for the treatment of radiocarpal osteoarthritis, each of them depending on the underlying cause of the osteoarthritis and its clinical characteristics; however, the most used techniques such as intercarpal arthrodesis, total wrist arthrodesis and proximal row carpectomy present some complications such as loss of mobility, loss of strength or secondary radiocapitated osteoarthritis. This is why we developed a technique that in the short term shows an acceptable range of joint mobility, with preservation of strength and considerable improvement in pain. Conclusions: We present the short-term results of a technique that promises to be a viable, reproducible and useful option as part of the therapeutic options in the treatment of wrist osteoarthritis.
Non-vascularized bular autograft for post-traumatic bone defect in thumb phalanx
Traumatic thumb injuries often result in signi cant functional disability. With segmental bone loss, reconstructive options include multiple options such as antibiotic cement and bone graft, distraction osteogenesis, digital transfers, vascularized and avascularized free bone grafts, among others. We present a case about a complex bone lesion in proximal phalanx of the thumb on the left hand and how, through a reconstruction with avascular bone autograft of the bula, the anatomy was restored providing stability, strength and function with a satisfactory nal result.
Preliminary results with the Kessler-Tsuge knotless technique to Zone II Flexor Tendon lacerations: – a case series study
Introduction : Flexor tendon injuries have an annual incidence of 33 x 100,000. Zone II lacerations account for the most difficult to repair. There is no true consensus regarding a technique or the best suture material to be used. A strong suture with a high tensile strength avoiding avascularity changes, provide the ability to expedite the rehabilitation protocols. The goal of this study is to evaluate the results of the Kessler-Tsuge knotless technique. Methods: Thirty patients with Zone II flexor tendon lacerations were included from 2017 to 2020 in this prospective multicenter series of cases study. The Kessler-Tsuge knotless repair technique with 4-0 FiberLoop was used on all the tendon lacerations. Results: A total of 30 surgical procedures were performed with the described technique. Sixteen patients were lost to final follow-up. The average age was 26 with a median of 20. The small and ring fingers were the most commonly injured (57% and 35% respectively). Duran’s flexor tendon rehabilitation protocol was used. At the first month, the average range of motion (ROM) was 65° PIP and 43° for the DIP joint and ROM of 92° PIP and 72.5° DIP joint at 3 third month. The Visual Analogue Scale (VAS) for pain was 2 at 3 months. There were no any re-ruptures at final follow-up. Discussion: kessler-Tsuge technique is a safe and reproducible technique that allows for a hidden knot at the A2 pulley level with a configuration of 4 core strands in two passes. Furthermore, it does not cause shortening of the ends, provides a homogeneous and smooth bed for tendon gliding, allows for an expedite post-operative protocol, and displayed good functional results at 3 months post- operative.
Arthroscopic capsular anchoring repair in patients with peripherial injuries to the triangular fibrocartilage complex: functional outcomes at six months followup
Introduction: Injuries to the triangular fibrocartilage complex (TFCC) are a frequent diagnosis in the practice of hand surgery. Standardized treatment depends on the level of involvement of the distal radio-ulnar ligaments (RCD) in the wrist. Objectives: To describe the functional results of arthroscopic repair with capsular anchorage in patients with peripheral injuries to the TFCC and their postoperative evolution at 6 months followup. Material and methods: Patients were included in a retrospective cohort, with a diagnosis of peripheral injury to the TFCC, treated by capsular anchorage, with a 6-month follow-up. The patients were evaluated from March 2018 to December 2020, using QuickDASH and the Mayo Wrist Score, before the surgical procedure, and at 3 and 6 months after surgery. Results: The mean time to injury in our patients was 11 weeks (range 4-24 weeks). Average time of physical therapy was of 4 weeks (range 3-6 weeks), with authorization to return to sports activity at 3 weeks. There were 4 complications, of which 1 did not improve, 2 patients had resolved transient ulnar paresthesia, and 1 resolved superficial soft tissue infection. Conclusion: The capsular anchoring technique developed in the study is reproducible with satisfactory results, using scales such as the QuickDASH and the Mayo Wrist Score.
Síndrome del túnel carpiano causado por un ganglión oculto en el túnel carpiano: Reporte de caso
Carpal Tunnel Syndrome (CTS) is a common medical condition that remains one of the most common forms of median nerve compression at the wrist level. Although CTS is usually idiopathic, in some patients a certain etiology can be detected. Space-occupying lesions are known to cause CTS, and the incidence of space-occupying lesions in unilateral CTS is higher than in bilateral CTS. It is easy to detect a mass when it is palpable; however, hidden injuries are often overlooked. Cases of carpal tunnel syndrome secondary to ganglion cysts are rare in the literature. We present the case of a patient with persistent carpal tunnel syndrome associated with the presence of a ganglion inside the carpal tunnel confirmed by nuclear magnetic resonance.
Sub-acute hematogenous carpal osteomyelitis with secondary septic arthritis in a pediatric patient: Case Report
A case is presented, a 5-year-old male patient with a diagnosis of subacute hematogenous osteomyelitis of the scaphoid, trapezius, large bone, lunate and distal radius segment, with associated intercarpal and radiocarpal septic arthritis, without history of previous skin lesions. Clinical diagnosis was confirmed by laboratories, X-rays, MRI and intraoperative findings; negative microbiological cultures. Managed with surgical drainage and intravenous antibiotic treatment with postoperative clinical improvement. The current literature reports few cases of osteomyelitis in the carpus in the pediatric population and they are associated in most cases with underlying skin lesions. This case is interesting since not only is an isolated carpal osteomyelitis reported, but also presents secondary septic arthritis.
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Idiopatic avascular necrosis of the capitate, Jonsson’s disease: a case report
Introduction. Avascular necrosis (AVN) of the capitate bone is a rare disease of unknown etiology that usually appears in young people and causes chronic pain and functional impotence in the wrist. There are multiple treatments for this pathology; however, there is currently no clear consensus on the indications for these techniques. Presentation of the case. A 27-year-old woman who attended the Orthopedic Surgery and Traumatology Service of a tertiary care institution for pain in the left wrist that she began eight months ago. As the only antecedent of importance, she had presented a blow in the area. No alterations were found in the X-ray presented by the patient. Nuclear magnetic resonance (NMR) was ordered, which showed an extensive trabecular fracture of the capitate with signs of pseudoarthrosis and bone edema, for which conservative management was initiated. In the follow-up MRI, performed one year later, persistence of bone edema was observed, so AVN of the capitate was suspected and a computerized axial tomography was performed, which confirmed the diagnosis. The patient was treated by arthroscopic resection of the proximal pole of the capitate with good short-term results. Conclusion. It is necessary to carry out new studies with long-term results that compare the different therapeutic options to clarify the best treatment for this rare disease.
Parascapular free flap in electric burn coverage: case report
Introduction. Upper limb reconstruction represents a challenge. Electrical burns produce devastating injuries in which free flaps are one of the best alternatives for early coverage with satisfactory results. Clinical case. A 46-year-old man with high-voltage electrical burns involving 35% of the total body surface area; the burns, which were 2nd and 3rd degree, were located on the trunk and extremities. The patient, who was managed by the intensive care unit, plastic surgery, orthopedics and wound clinic, presented a residual coverage defect in the wrist, compromised median nerve and ulnar artery, exposed flexor and extensor tendons and radial artery without injuries. On hospital day 23, reconstruction of the median nerve was performed with a sural nerve graft, and coverage with a parascapular free flap. At four months postoperative he had a satisfactory evolution. Conclusion. The subscapular system allows chimeric free flaps to be performed, useful for releasing contracted joints, reducing the risk of infection, protecting vital structures and reducing hospital stay, as well as helping to avoid amputation and allowing early rehabilitation.
Phalanx transfer to make a two phalanges finger
The hands are especially vulnerable to traumatic injuries, the fingers being the most frequently injured area, especially in the workplace, which entails serious complications for both the patient and the health system. Several techniques have been postulated in the management of severe injuries to the fingers. These techniques have the objective of maintaining length and functionality; Under these principles, the best alternatives are sought to achieve that; Thus, the pedicled transfer of the distal phalanx to the middle phalanx position is proposed to make a two phalanges finger. We present the authors’ clinical and surgical experience with the use of this technique for the management of severe injuries on the middle phalanx of the digits with the objective of maintaining the greatest amount of viable tissue and functionality of the hand. With the described technique, good functional and aesthetic results are observed in the short and medium term, and this option can be considered as a valid technique for the management of lesions at the level of the phalanges in which the distal end is still viable.
Hand and Upper Extremity Transplant. A bioethical view in a middle income country
Tissue transplantation has developed rapidly since its introduction in the last century, saving and transforming hundreds of thousands of lives around the world. The transplant of nonessential tissue such as the hand entails a special ethical conflict, given the high financial cost, the need for resources from health systems and the need for immunosuppressive medication for the recipient. The main aspects related to the possibility of introducing this type of intervention in a middle-income country are discussed.
Left supraclavicular lipoma associated with the brachial plexus trunks. Case report
Introduction: Lipomas are the most common soft tissue tumors. However, its location in the brachial plexus is extremely rare. Clinically, they can be manifested by insidious compressive symptoms since they are involving the nerve structures and the treatment is surgical resection in indicated cases. Materials and methods: The case of a 56-year-old patient with progressive edema of the left upper limb, episodic paresthesias, and weight sensation of two years of evolution is reported. Magnetic resonance imaging documented the presence of a 6 x 8 cm encapsulated mass located in the topography of the trunks and divisions of the left brachial plexus in intimate contact with the subclavian vessels. The treatment performed and literature review are described. Conclusion: Lipomas associated with the brachial plexus trunks are rare benign entities with progressive growth that can cause compressive sensory and motor symptoms. Surgical treatment is a safe therapeutic option when is performed by a trained surgeon due to the risk of nerve injury during surgical resection of the mass.
Double Dorsal Capsulodesis in the Treatment of Chronic Scapholunate Instability: Description of a New Surgical Technique and Case Report
Introduction: The scapholunate ligament (SLL) injury can cause wrist pain and instability. There is a wide variety of surgical techniques used for the treatment of this lesion, such as dorsal capsulodeses, tenodeses with flexor or extensor tendons, and bone-ligament-bone graft. Objective: To describe a new technique for the treatment of SLL injury aiming to stabilize the dissociated carpus with a double dorsal capsulodesis. Materials and methods: By presenting the case of a 36-year-old male security officer who injured his left wrist in a motorcycle accident, a procedure to align the carpus is proposed. The long-term outcome of this procedure is also described Results: The proposed surgery was successfully performed; it had excellent clinical and functional results, with no complications. Long-term restoration of carpal alignment observed in wrist radiographs was evidenced after two years of follow-up, the patient was asymptomatic and with full functional recovery. Conclusion: The proposed technique appears to be reproducible, effective and easy to perform. Unlike the technique described by Blatt, the aim of this one is to restore the physiological position of the lunate bone by adding a second capsulodesis, as it is believed to be an essential factor in the maintenance of carpal kinematics.
Endoscopic carpal tunnel release results. Clinical cases
Introduction: Carpal tunnel syndrome is the most common compressive neuropathy and surgical treatment implies transverse carpal ligament release. The purpose of this study is to describe the outcomes and postoperative complications in patients undergoing endoscopic carpal tunnel release at a university hospital in Colombia. Methods: This was a retrospective case series including patients aged >14 years who underwent endoscopic carpal tunnel release between January 2011 and December 2014. A follow-up was performed at 1 and 6 months after surgery, and clinical outcomes and complications were assessed. Results: During the study period, 270 patients who underwent endoscopic carpal tunnel release were included. One month after surgery, 27 patients were lost to the follow-up. Of the 243 remaining, 171 exhibited no residual symptoms (sensory alterations, alterations in strength, or nocturnal awakenings). Six months after surgery, 146 patients assisted to the follow-up appointment, of which 124 exhibited no residual symptoms. The most prevalent complication was chronic pillar pain, which occurred in 23 of the 146 patients (15.8%). No neurovascular injury was reported. Conclusion: Endoscopic carpal tunnel release is a safe and effective procedure for the surgical management of carpal tunnel syndrome. Level of evidence: IV
Treatment of midshaft clavicle fracture with Intramedullary Nailing versus Plate
Introduction: Titanium elastic nail osteosynthesis has increasingly been used as a minimally invasive alternative for displaced midshaft clavicle fracture management (AO/OTA 15.2A). However, its use remains controversial because of its complication profile. Methods: A retrospective comparative study of 99 surgically managed displaced midshaft clavicle fracture with elastic nails or plate fixation in four hospitals was performed. Functional result was Functional result was calculated using the Constant and Quick-DASH scores. Results: Sixty-one osteosynthesis with elastic nails and 38 plate fixations were reviewed. Osteosynthesis with elastic nails shorter surgery time minutes; smaller scar, and higher Constant score than plate fixation. Alterations in consolidation and scar numbness were higher in plate fixation. However, irritative symptoms and prominence of material were higher in osteosynthesis with elastic nails. Conclusion: Intramedullary fixation with elastic nails for displaced midshaft clavicle fractures offers a minimally invasive alternative with better aesthetic and functional results, and fewer major complications, compared to plate fixation.
Editorial Cirugía de Mano y Microcirugía
Este primer número de la revista Cirugía de mano y microcirugía es el fruto de un proyecto académico de la Asociación Colombiana de Cirugía de la Mano (ASOCIMANO) y el resultado del trabajo de muchas personas que trabajaron en pro de unos mismos pensamientos, sueños e ideas.
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What have we learned about the wrist in recent years? From lab to clinical practice
More than a decade ago, a group of friends interested in the Anatomy and Biomechanics of the wrist began to spend hours in the Anatomy Departments of the two most important Universities in Barcelona, without expecting any other reward than learning and satisfying our concerns. Taking advantage of the launch of the journal of Hand Surgery and microsurgery from Colombian Association of Hand Surgery, we have decided to take stock of the accumulated learning. Regardless of the knowledge that we have acquired and disseminated; the main conclusion of this balance is the need for teamwork to move forward. Like any team, ours also needed captains to lead it. We were lucky and honored to have Dr. Marc Garcia-Elias as our guide, and Professors Manuel Llusá and Alfonso Rodríguez Baeza as unconditional support. This writing is a small summary of the work of our group during these more than 11 years in the Laboratory of Biomechanics of the Wrist, and of its potential applications in the clinic.
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Open osteochondral fracture of the distal phalanx tuft in young children’s fingertip: a frequently non-diagnosed injury
The hand is the region of the body most affected by trauma in children. Crushing trauma to the fingertip often occurs in young children. Often, in the emergency department, little importance is given to the correct treatment of these injuries, often leaving important sequelae. In young children, less than four years of age, the proximal epiphysis of the distal phalanx is not calcified, so it is not visible on radiographs. Also, the calcified portion of the phalanx is much smaller. In this age group, proportionally, compared to older children, the fingertip is formed and supported more by soft tissues (pulp) and by cartilage, since the phalanx is covered over its entire surface by a chondral cap. Thus, at this stage, during a crush injury, with flexion of the distal portion of the fingertip (a mechanism like Seymour’s fracture), the most fragile region is the osteochondral junction of the phalanx tuft. This results in a detached nail plate injury, sterile nail matrix injury, and skin laceration with exposed bone and osteochondral fracture. Our objective is to describe this type of fingertip crush injury in young children, with exposed osteochondral fracture associated with damage to the nail matrix, and his treatment. This injury is an open fracture that compromises the distal osteochondral junction, behaving very similarly to the Seymour fracture that is located proximally in the phalanx. We want to draw attention to the fact that the generalized idea that injuries in children evolve well, despite the severity and regardless of the treatment carried out, is wrong in many cases.
The lacertus fibrosus of the biceps brachii or aponeurotic expansion of the biceps is a structure to which little attention is generally paid compared to other myotendinous units of outstanding importance such as the biceps or the triceps. For this reason, in general, little is known about it in regard to its anatomy, biomechanics, physiology, and much less in terms of her pathology. In descriptions of pronator teres syndrome, it is incidentally mentioned. This is a retrospective descriptive observational study with the purpose of reviewing its related anatomy, outline some biomechanical aspects and present the review of a series of 29 cases identified from 4100 medical records in a 5 year period from January 13 2015 to February 12 2020; during that period of time, we found the disease to affect more frequent women over 56 years of age, being the main reason for consultation pain on the anteromedial aspect of the proximal forearm and being frequently associated with pronator teres and posterior interosseus syndromes.
Saving Cost of Hospitalization with the WALANT technique in the surgical resolution of Carpal Tunnel syndrome and De Quervain’s tenosynovitis. Cost evaluation in a private hospital in the city of Quito
Introduction: The benefits of the use of regional anesthetic technics have increased the interest in the last years as they allow to carry out several surgical procedures in the hand and the wrist safely performed on an outpatient basis, without the side effects of the general anesthesia or the need to monitoring in the post-anesthetic care unit, decreasing the usage of hospital resources. Objective: To determine the economic impact of the WALANT technique compared to general anesthesia in surgical procedures of the hand. Material and Methods: In this work, the costs of 14 patients operated with the WALANT anesthetic technique versus 13 patients operated under general anesthesia are presented. Results: The surgeries carried out through WALANT were achieved in a lower cost in comparison to the general anaesthesia. Conclusions: The Carpal Tunnel Syndrome and De Quervain’s Tenosynovitis surgery under local anaesthesia no tourniquet and with the patient awake (WALANT) allows reducing costs at an average of $391,80 54.36% percent.
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Lesiones del plexo braquial en adultos. Parte 1: Anatomía, examen físico y evaluación
Introduction: The Brachial plexus is an intricated network of nerves that provide motor and sensory innervation of the shoulder girdle and the upper extremity. A variety of mechanisms may injure the nerves at different locations to a variable degree. Most severely the nerves are avulsed from spinal cord resulting in global loss of function and sensation of the upper extremity. Purpose: This paper intends to review the anatomy of the Brachial Plexus, Mechanisms and Patterns of Injury, and to provide guidelines for a structured physical examination. Additionally, the role of diagnostic and supporting studies will be reviewed. Results: Knowledge of the anatomy of BP assists in identifying location of injury as well as treatment options. Closed traction is the most common mechanism and most of BP injuries are pan plexal at presentation. Physical examination is key in ruling out life threatening situations, diagnostic test interpretation and treatment decision making. CT Myelogram remains the gold standard in diagnostic imaging. Nerve electrophysiologic studies (EMG, NCS, SSEP/MEP) are the most reliable way of identifying nerve injury and document the earliest signs of recovery. While a variety of treatment options are available to restore function, the options chosen depend on which nerves are injured and what the exam findings are. Conclusion: Prognosis in Brachial plexus injury lies on correct and prompt diagnosis. The multifactorial diagnosis process intends to narrow the options helping the surgeon decide the best course of treatment.
Surgical treatment of acute perilunate dislocations and fracture dislocation in a specialized center
Introduction: Acute perilunate dislocations and fracture-dislocations are rare, high energy injuries and difficult to treat due to the extensive soft tissue, cartilage, and bone involvement. Different treatment options have been recommended with a recent trend in open reduction and internal fixation. Objective: To evaluate a cohort of patients who received specific surgical treatment for acute perilunate dislocations and fracture dislocations in a specialized center in trauma and hand surgery. Methods: Descriptive cross-sectional study performed in 20 patients diagnosed with acute perilunate dislocations and fracture-dislocations treated surgically. Patients who underwent surgery between February 2008 and February 2014 were assessed and sociodemographic data, trauma mechanism, follow-up time, visual analog pain scale, DASH scale and joint mobility arches were assessed. The clinical results were obtained through a personal interview and clinical assessment. Results: The average age of the patients was 32 years old and the dominant hand was the most affected (80%). Perilunate dislocations were the most frequent (50%), followed by transscapholunar (40%) and transstyloradial (10%) dislocations. 2 complications were founded. Conclusions: All patients underwent a timely surgical procedure and had a good recovery, so it is established that early surgical treatment (<72 hours) is an important factor in obtaining favorable clinical and functional results. This is the first study that analyzes the results of surgical management of these conditions in Colombia.