Marco Sousa

Scapholunate Ligament Reconstruction Using a Flexor Carpi Radialis Tendon Graft

PURPOSE To review the results of scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. METHODS We performed a retrospective review of 22 patients with post-traumatic scapholunate instability who were treated with a modification of the Brunelli, a flexor carpi radialis tendon graft. RESULTS The mean follow-up was 61 months. The average age was 40 years. The average loss of flexion was 23° and of extension was 22° compared with the contralateral side. Grip strength averaged 67% of the nonoperated side. All patients except 2 returned to work. Degenerative changes were seen in 3 patients at the time of revision. Complications occurred in 2 patients and included avascular necrosis of the scaphoid. CONCLUSIONS Perfect biomechanical reconstruction might not be possible for scapholunate dissociation. Our results show, however, that ligament reconstruction led to satisfactory results from the patients point of view. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

Cubital compressive neuropathy in the elbow: in situ neurolysis versus anterior transposition – comparative study

Objective To compare the results from two of the most commonly used surgical techniques: in situ decompression and subcutaneous transposition. The processes of patients treated surgically in a public university hospital between January 2004 and December 2011 were reviewed. Cases of proximal compression of the nerve, angular deformity of the elbow and systemic diseases associated with non-compressive neuropathy were excluded. Methods Ninety-seven cases were included (96 patients). According to the modified McGowan score, 14.4% of the patients presented grade Ia, 27.8% grade II, 26.8% grade IIb and 30.9% grade III. In situ neurolysis of the cubital was performed in 64 cases and subcutaneous anterior transposition in 33. Results According to the modified Wilson and Knout score, the results were excellent in 49.5%, good in 18.6%, only satisfactory in 17.5% and poor in 14.4%. In comparing the two techniques, we observed similar numbers of excellent and good results. Grades IIb and III were associated with more results that were less satisfactory or poor, independent of the surgical technique. Conclusion Both techniques were shown to be efficient and safe for treating cubital tunnel syndrome.

indicatiOns fOr distal radiOulnar arthrOplasty: repOrt On three clinical cases

Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up.

Indicações de artroplastia radiocubital distal: relato de três casos clínicos

Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauve-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up.