No abstract

<p><strong>Objetivo: </strong>Describir y analizar una técnica de osteosíntesis palmar de radio distal con preservación del pronador cuadrado.</p><p><strong>Materiales y Métodos: </strong>Se revisaron, en forma retrospectiva, 24 pacientes operados con esta técnica (16 mujeres y 8 hombres; edad promedio 65 años). Doce fracturas eran de tipo A; 7, de tipo B y 5, de tipo C. La técnica quirúrgica consiste en practicar una incisión cutánea de 25 mm y profundizar hasta observar el pronador cuadrado. Sin seccionarlo, se realiza una disección de su borde distal, a fin de introducir la placa bloqueada volar por debajo del músculo. Se colocan los tornillos distales bajo visión directa y los tornillos proximales, en forma percutánea. La evaluación posoperatoria se llevó a cabo mediante análisis clínico-funcional y radiográfico.<strong></strong></p><p><strong>Resultados: </strong>En el último control, todos los pacientes presentaban signos clínicos y radiográficos de consolidación ósea. El puntaje en la escala DASH fue, en promedio, de 4,8. Se observó una inclinación palmar posoperatoria de la superficie articular del radio de 14,3º promedio y una inclinación radial de 26,3º promedio. No se detectaron complicaciones relacionadas con la fractura, el implante o la herida quirúrgica en ninguno de los controles posoperatorios.</p><p><strong>Conclusiones: </strong>Sin bien no existe bibliografía que demuestre que la técnica mininvasiva sea superior, sostenemos que el hecho de obtener resultados similares con ambos abordajes (mininvasivo y convencional) justifica llevar a cabo esta técnica con preservación del pronador cuadrado, sobre todo en los pacientes preocupados por el aspecto cosmético de la cicatriz.</p>

Objective The objective of the study is to analyze the clinical and radiological results obtained using a minimally invasive fixation technique with a volar locking plate and a suspension system with a dorsal button in distal articular radius fractures with dorsal comminution. Materials and Methods Six patients with distal radius fractures, between 19 and 68 years of age, were included in the study. Mean follow-up was of 15 weeks. Range of motion (ROM) in flexion, extension, radial deviation, ulnar deviation, pronation, supination, the strength in kilograms, and values on the Visual Analog Scale (VAS), Disabilities of Arm, Shoulder and Hand (DASH), and Mayo Wrist Score (MWS) scales were evaluated at 4, 8, and 12 weeks postoperative. Correction of anteroposterior diameter of the radius and concordance between postoperative anteroposterior diameter and the contralateral wrist diameter were evaluated radiologically. Results The following mean values were obtained at 12 weeks postoperative: ROM in flexion: 40.5°, ROM in extension: 49.5°, ROM in radial deviation: 24.5°, ROM in ulnar deviation: 15°, ROM in pronation: 87°, ROM in supination: 89°, strength: 37.5 kg, pain in VAS scale: 2 points, DASH: 54.5 points, and MWS: 67.5 points. At 12 weeks postoperative, the mean correction of anteroposterior diameter was 0.49 mm. The anteroposterior diameter and that of the contralateral wrist were strongly correlated. Conclusion Fixation with the volar locking plate and dorsal suspension button could be considered an alternative to dorsal plate fixation for treatment of distal radius fractures with comminution or associated dorsal die punch fragments.

Radial head replacement in complex elbow fractures (Mason III) with either bony or ligamentous injuries or interosseous membrane rupture is unquestionable. Actual modular and metallic prosthesis ease the mounting technique and ensure durability. Nevertheless, these types of prostheses are not always available in a short time in our daily practice. We present the use of a transient polymethacrylate spacer as an alternative in nonreconstructable complex radial head fractures with a unstable elbow. We assessed 38 patients between 2006 and 2007, with a median follow-up of 53.8 months. We included 14 Mason IV; 8 Monteggia (posterior); 7 Mason III with either associated medial collateral ligament or interosseous membrane injury; 6 elbow triads; and 3 Essex-Lopresti lesions. With the Mayo elbow performance score and the disabilities of the arm, shoulder, and hand score questionnaire, we assessed the functionality. Anatomic results were evaluated with x-ray scans of the elbow and wrist using the Broberg and Morrey and the Knirk and Jupiter scales. Functional results were as follows: 14--excellent, 14--good, 8--fair, and 2--poor. Assessment through disabilities of the arm, shoulder, and hand score questionnaire was 18.7% in average. There was a statistically significant relationship between joint stability and motion. Of the patients, 70% showed mild or moderate chondromalacia of the capitellum and 90% showed osteolysis on the proximal metaphysis of the radius, both events related to follow-up time but not to pain or range of movement. Of the cases, 30% showed heterotopic calcifications and 35% showed moderate arthrosis between the ulna and the humerus. None of the patients presented wrist arthrosis. Complications were 1 deep infection and 1 spacer luxation because of fatigue and ulna plate rupture (Monteggia posterior). In 6 patients, we had to remove the spacer because of pain and/or functional limitation, and 2 of these patients remained with moderate valgus instability after removal. We consider using this type of spacer in those complex situations in which the definitive prosthesis is not available, because it is cheap and resistant to axial and valgus forces. In spite of the good anatomic and functional results obtained and the low complication rate, we firmly think that the spacer should only be used in a transient manner and in special situations, although in this series, only 8 of the 38 patients have accepted to have the spacer removed.