Carlos Rodolfo Zaidenberg

Injerto óseo vascularizado pediculado del radio distal para tratar la seudoartrosis recalcitrante del cúbito. [Vascularized bone graft of the distal radius for recalcitrant ulnar pseudoarthrosis.]

Introduction The purpose of this study was to analyze the clinical and radiological outcomes of a series of patients treated with the pedicled distal radius vascularized bone graft (VBG) for recalcitrant ulnar nonunions. Methods A retrospective study was perfomed. The inclusion criteria were patients with diaphyseal or proximal ulnar nonunions with bone defects smaller than 6 centimeters, at least three previous surgeries and a minimum follow-up of 2 years treated with pedicled VBG of the distal radius. The number of previous surgeries was recorded. The elbow and wrist range of motion, the comparative grip strength, the Visual Analogue Scale (VAS) for pain, the QuickDASH questionnaire and the Mayo Score for elbow were evaluated. Results Seven patients were included. The mean age was 42 years (range 26-64). The average number of previous surgeries was 4 (3-7). The mean follow-up was 21 months (range 24-36). All pseudoarthrosis consolidated. The Mayo score was good in 4 patients, excellent in 2 patients and moderate in one patient. The mean postoperative QuickDASH was 13 (0-29). The flexion-extension arch of the wrist was 81% of the contralateral. The elbow range of motion was > 100° in 5 patients and 50°- 100° in 2 patients. Conclusion The pedicled vascularized bone graft of the distal radius is an effective alternative for the treatment of recalcitrant ulnar nonunions.

Innervation of the interphalangeal joint of the thumb: anatomical study:

We dissected 30 cadaveric thumb interphalangeal joints to delineate the sensory nerve anatomy of its capsule. Four articular branches supplying the interphalangeal joint capsule of the thumb were found in all specimens. Ulnar and radial proper digital nerves provide one palmar capsular nerve branch on their respective sides. Of the two dorsal branches of the radial nerve at the dorsum of the thumb, we observed that each nerve provided one branch to the interphalangeal dorsal capsule. Our findings demonstrate a consistent pattern of innervation and may provide the anatomical basis to the treating surgeon for an effective and safe denervation of the interphalangeal joint of the thumb.

Vascularized Distal Radius Bone Graft for Treatment of Ulnar Nonunion

Various methods have been reported to treat forearm nonunions with good results. However, in the presence of infection, inadequate vascularity of surrounding tissues, or failed prior grafts, vascularized bone grafts are a valid alternative. We describe the surgical technique to obtain distal radius vascularized bone graft pedicled on the radial artery (RA) and its clinical application in 1 case of an ulnar nonunion. We studied the surgical technique in 12 freshly injected cadavers. In the distal forearm, the RA provides several periosteal branches to supply the distal radius metaphysis. These vessels are located between the distal insertion of the brachioradialis and the deep surface of the radial half of the pronator quadratus. A 6-cm vascularized bone graft can be harvested from the radius, and dissection of the RA enables a long pedicle with a wide arc of rotation readily able to reach the proximal part of the ulna. The present technique is a reproducible alternative that allows the treatment of bone defects up to 6 cm, without the potential technical difficulties of a free bone flap.

Metacarpal Aneurysmal Bone Cyst En Bloc Resection Reconstructed With Osteoarticular Allograft

Aneurysmal bone cysts are large lytic lesions that appear most often around metaphyseal bone. The lesions are locally aggressive with high recurrence rates. Therefore, wide resection is commonly necessary, leading to challenging reconstruction of the defect, especially when the articular surface is involved. We present a case of an aneurysmal bone cyst of the fourth metacarpal, treated with an en bloc resection and reconstruction with a metacarpal osteoarticular allograft. At 8 years after surgery, the patient has shown no signs of recurrence, but radiographic articular reabsorption was noted. However, the patient showed an excellent outcome with a satisfactory active range of motion and grip strength. Despite potential complications, osteoarticular allograft is a feasible alternative when autologous osteoarticular reconstruction is not an option.

Tratamiento quirúrgico de las fracturas mediodiafisarias desplazadas de clavícula mediante placas pre contorneadas con técnica miniinvasiva. [Surgical treatment of clavicle displaced midshaft fractures with pre-contoured plates using minimally invasive technique (MIPO)]

Introduccion: Las fracturas mediodiafisarias de clavicula representan hasta el 10% del todas las fracturas del esqueleto. El tratamiento conservador en trazos con leve deformidad y desplazamiento brinda en general buenos resultados con baja incidencia de complicaciones. Sin embargo, ante trazos desplazados, multifragmentarios o con deformidad significativa el tratamiento quirurgico debe considerarse. Se presenta una serie de casos retrospectiva con el proposito de exponer nuestra experiencia en el tratamiento de fracturas cerradas, desplazadas y mediodiafisarias de clavicula con placas pre-contorneadas con tecnica MIPO, descripcion de la tecnica y resultados funcionales preliminares. Materiales y metodos: Se presenta una serie retrospectiva de 13 pacientes (11 varones [84,6%] y 2 mujeres [15,4%]), media de edad de 31 anos, con fracturas diafisarias cerradas desplazadas de clavicula clasificadas tipo 2 B segun Robinson (Edinburgo) tratadas mediante reduccion y osteosintesis con placas de osteosintesis pre-contorneadas con tecnica mini invasiva (MIPO) entre abril del 2010 y noviembre de 2013. Seguimiento promedio de 13 meses (rango 11 a 25).Se realizaron controles radiograficos y TAC, valorando la funcionalidad mediante las escalas de Constant – Murley modificada, Quick DASH y dolor por escala visual analogica (VAS). Resultados: En promedio, el tiempo transcurrido hasta la cirugia fue 8 dias, el tiempo quirurgico 35 minutos y 1.28 dias postoperatorios de internacion, registrandose consolidacion clinico-imagenologica en todos los caso en 15.2 semanas de media. La puntuacion promedio en escala de Constant – Murley modificada fue 96 puntos, Quick DASH 29.5 y VAS de 0.3. No se registraron complicaciones sistemicas ni cosmeticas. Discusion : En la presente serie, l a osteosintesis mini invasiva (MIPO) en fracturas cerradas mediodiafisarias desplazadas de clavicula, represento una tecnica reproducible con tiempo quirurgico reducido y scores funcionales aceptables, sin complicaciones de relevancia.