Alejandro Badia

Arthroscopic indications and technique for artelon interposition arthroplasty of the thumb trapeziometacarpal joint.

Advanced basal joint arthritis that has failed conservative treatment has traditionally been treated with some type of procedure that encompasses complete trapezial excision. An arthroscopic technique entailing only minimal trapezial debridement coupled with insertion of a synthetic interposition material is described. This provides the implicit benefits of a minimally invasive procedure, with less pain and faster recovery, along with the great advantage of trapezium preservation. The surgical technique is described along with a preliminary clinical series supporting its use.

Correlation of wrist ligamentotaxis with carpal distraction: Implications for external fixation

Cadaver forearms were tested to measure carpal bone separation and wrist ligament tension in response to MTS-based incremental wrist distraction. Distraction of 2 mm separated the proximal carpal row from the radius and transmitted an average tension of 8 N. The mid-carpal joint also began to widen at this level of distraction. Distraction of 4 mm resulted in an average tension of 20 N. At this level of distraction, radioscaphoid separation started to exceed radiolunate separation. A transition from low- to high-stiffness response was observed over a range of 4-8 mm distraction for the 12 specimens tested, with an average tension of 80 N associated with 8 mm distraction. Average values of carpal height ratio, revised carpal height ratio, and carpal height index were found to be poor indicators of distraction, owing to their high variability between specimens.

Functional outcome of arthroscopic assisted fixation of distal radius fractures

Background: Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures. Materials and Methods: We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months). Results: Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score. Conclusion: The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.

Management of Elbow Ankylosis in a Head Injured Patient With Floating Elbow Injury

The development of heterotopic ossification around the elbow has been linked to trauma (particularly fractures or dislocations), closed head injury, spinal cord injury, burns of the extremity, genetic traits, adult respiratory distress syndrome, and orthotopic liver transplant. Pain and lack of motion are the most common complaints during the progression of ectopic bone about the joint. Opposite to common credence, fracture healing is not accelerated in patients with traumatic brain injury. Formation of heterotopic bone is not a clinically significant form of healing, therefore healing rates of patients with traumatic brain injury should coincide with those of the general population. Heterotopic bone formation on the medial side of the elbow can cause cubital tunnel compression and ultimately result in ulnar neuropathy. The literature is devoid of any report concerning ectopic bone formation in traumatic brain injury with simultaneous bony trauma to the affected arm. This article presents a case of a patient with a chronic rigidly ankylosed elbow secondary to heterotopic ossification, after suffering a traumatic brain injury, complex periarticular elbow fractures, and an ipsilateral segmental forearm fracture.