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Introduction Management of distal radius fractures remains controversial despite their high frequency. Elderly patients specifically present a high rate of secondary displacement, sometimes requiring a complex reconstructive surgery. The surgical treatment of displaced fractures evolving for several weeks in elderly patients has not been clearly reflected in the literature. This study aims to show clinical and radiological outcomes from this particular situation. Material and Methods Retrospective study of 31 cases of distal radius fractures with more than 2 weeks of evolution. Fractures were graded according to the Fernández's classification. Pre- and postoperative radiological studies were carried out to evaluate the degree of correction achieved. A clinical evaluation was performed using the Mayo Wrist Score. Data on arthroscopy and bone substitutes use, specific surgical tips and complications were also collected. Results Thirty-one patients with a mean age of 76 years old were operated for distal radius fracture with a delay in surgical treatment of 22 days. The most frequent fracture pattern was Fernández type III (38.7%). The clinical outcome according to the Mayo Wrist Score was 81.94 points with no relationship to fracture pattern or arthroscopic assistance. A statistically significant improvement was achieved for the correction of radial inclination, joint gap and ulnar variance. No statistically significant improvement was achieved in volar tilt correction. Complications were observed in 12.9% of the cases. Conclusions Delayed surgical treatment of distal radius fracture in elderly patients provides similar results to those observed in other age groups and time of evolution. Despite not being the ideal scenario for the surgeon, it should be considered to avoid functional deterioration in this fragile age group.

Introducción La etiología y el manejo de los gangliones sigue en controversia pese a su elevada frecuencia. Concretamente el tratamiento del ganglión volar de muñeca se ha asociado a un mayor índice de recidiva y complicaciones comparado con el ganglión dorsal. En los últimos años, se ha desarrollado el tratamiento artroscópico con el fin de realizar un tratamiento menos invasivo y poder identificar una relación causal. El objetivo del estudio es determinar la presencia de lesiones intraarticulares asociadas al ganglión volar y si el tratamiento de ambas patologías puede ser una opción válida. Material y Método Estudio longitudinal en el que se intervinieron de forma consecutiva 21 pacientes de ganglión volar de muñeca por vía artroscópica. Se recogieron los datos sociodemográficos, exploración física, pruebas complementarias, región predominante de dolor (EVA) y cuestionario DASH pre y postoperatorio. Se asoció el tratamiento de las lesiones intraarticulares en el mismo acto quirúrgico si existía correlación clínica con la exploración física inicial. Resultados Todos los casos fueron intervenidos por vía artroscópica sin complicaciones intraoperatorias. Se observaron hallazgos artroscópicos en todos los casos siendo la mayoría lesiones del Fibrocartilago Triangular del Carpo (57,12%). Se obtuvo una mejoría en los parámetros de dolor y DASH postoperatorios siendo este último significativo en los casos de dolor cubital y dorsal asociado al ganglión (p Conclusiones Existe un gran número y variabilidad de lesiones intraarticulares asociadas al ganglión volar de muñeca. El tratamiento artroscópico es una herramienta versátil y útil ya que permite un tratamiento combinado. Se ha observado una mejora en los resultados postoperatorios con un escaso índice de complicaciones.

Pisotriquetral (PT) joint arthritis is a common cause of ulnar-sided wrist pain. Open pisiform excision is a well-established procedure and is indicated when the conservative treatment fails. Although arthroscopic visualization of the PT joint is part of the routine examination in a patient with ulnar-sided wrist pain, therapeutic arthroscopy of the PT joint is limited to one case in the literature through the standard dorsal portals. Arthroscopic pisiform excision is a novel technique described by the authors. The first aim of this procedure is pain relief maintaining wrist stability and strength. With this minimally invasive approach we believe that preserving the flexor carpi ulnaris and the PT ligament complex we maintain their biomechanical function, while at the same time, reducing scar tenderness and postoperative discomfort with better esthetic results and less recovery time. In addition to standard dorsal portals, a direct PT portal was used to have access to the PT space and as a working portal to complete the pisiform excision.

The indications of wrist arthroscopy are expanding with the advancement of technical and instrumental development. Most of the diseases in the joint can be managed by this minimally invasive technique with proper portal selection and establishment. This chapter describes in detail the various portals of radiocarpal and midcarpal joint and indications, contraindications, and arthroscopic techniques to manage various pathologies of the wrist joint, including acute and chronic scapholunate ligament injuries, acute lunotriquetral ligament injury, chronic lunotriquetral instability, arthrofibrosis of the wrist, extrinsic ligament injuries of the wrist, midcarpal instability, acute scaphoid fractures, scaphoid nonunion and scaphoid nonunion advanced collapse (SNAC) lesions, distal radius fractures, intra-articular malunions of the distal radius, perilunate injuries, Kienbock’s disease, inflammatory and degenerative arthritis of the wrist, osteochondral lesions, volar, and dorsal wrist ganglion.

The triangular fibrocartilage complex (TFCC) is the major stabilizer of the distal radioulnar joint. TFCC disorders may have traumatic or degenerative etiology. TFCC is most often lacerated at its ulnar periphery. According to the magnitude and direction of the traumatic force, the TFCC may rupture in a variable manner, and the ulnar styloid may also fracture, producing different subtypes of type 1B tears. Treatment options are variable, depending on the tear’s features. Atzei introduced in 2011 a novel treatment-oriented classification subdividing 1B-type lesions into five different classes according to the finding of special radiocarpal arthroscopic tests and distal radioulnar joint arthroscopy. In this chapter, the all-inside arthroscopic repair technique for Atzei class 2 and 3 TFCC foveal lesions is described.

Peripheral injuries of the triangular fibrocartilage complex can produce pain and instability of the distal radioulnar joint (DRUJ). There are several techniques for the repair or reconstruction of these injuries, which vary depending on the location, healing capacity, and viability of the tissues, as described by the classification proposed by Atzei. In irreparable chronic injuries of the triangular fibrocartilage complex in which there are no associated chondral injuries of the DRUJ or in failures in previous repair techniques, ligament reconstruction plasty with tendon grafts, either by open surgery or assisted by arthroscopy, are the treatments of choice. We present a completely arthroscopic reconstruction technique of the triangular fibrocartilage complex by means of tendon graft to provide stability to the DRUJ. This reconstruction technique provides a more stable reconstruction after the integration of the tendon plasty in the bone tunnels, based on the anatomic insertions of the triangular fibrocartilage in the fovea and in the corners of the dorsal and volar sigmoid notch, along with the advantages offered by arthroscopy in terms of recovery time, esthetic result, less mobility loss, and pain.

ResumenLas artrodesis parciales del carpo son una alternativa terapéutica para el tratamiento de las artropatías postraumáticas, degenerativas o reumáticas. El objetivo de estas cirugías es la resolución de la sintomatología dolorosa preservando la movilidad de las articulaciones sanas. La realización de estas técnicas por cirugía artroscópica ofrece unos resultados similares a los obtenidos con la cirugía abierta, pero además se minimizan algunas de las complicaciones de esta última.AbstractPartial arthrodesis of the carpal is an alternative technique for the treatment of posttraumatic arthritic, degenerative, or rheumatic disease. The aim of this type of surgery is the resolution of the painful symptoms and preserving the mobility of the healthy joints. Performing these techniques by arthroscopic surgery gives similar results to those obtained with open surgery, as well as minimizing some of the complications of the latter.