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Treating arthrosis in the base of the thumb has been a highly controverted subject. Many surgeries have been described, such as the isolated trapezium resection; resection with interposition with and without ligament plasty; arthrodesis, and arthroplasties. The purpose of this paper is to compare the two techniques which are currently the most used in this treatment.A prospective study has been made to compare the surgical results between the trapezium resection with tendon interposition (tenoarthroplasty) - 22 cases - and tenoarthroplasty associated to ligament plasty-24 cases. Objective evaluation was done by measuring opponence, movements of the metacarpophalangeal joint, pinch and grasp strength, radiographic measurement of the distance between the base of first metacarpal and the scaphoid, and measurement of the angle between the first and the second metacarpals. Subjective evaluation was done with a DASH questionnaire, visual analog scale to evaluate pain and patient satisfaction.After application of the criteria described and using Student 't' tests for statistical analysis, the authors concluded that the ligament reconstruction has no advantage over the simple resection and tendon interposition in carpometacarpal arthrosis of the thumb.

Objective: Wrist arthrodesis is a surgical procedure that should always be considered in cases of pathological conditions in which anatomical and functional structures are altered. In general, the results are very satisfactory, particularly for pain relief, and in the majority of cases, there is considerable functional improvement. Various techniques have been described, with different methods of internal fixation, most of which include the carpometacarpal joints in the fusion. The objective of this study was to evaluate the results from wrist arthrodesis using a technique that is simpler, more biological, less expensive, and does not involve the carpometacarpal joints. Methods: Fifteen patients with wrist arthrodesis were evaluated (six with sequelae from trauma, four with rheumatoid arthritis, three with Kienbock grade IV, one with Preiser and one with panarthrosis). The technique consisted of using an iliac bone plate and internal fixation with Kirschner wires, avoiding the carpometacarpal joints. Results: The evaluation was based on consolidation time (93% in seven weeks); movements of the fingers and pronosupination; pinch and grasp strength; functional evaluation through the DASH, pain and patient satisfaction questionnaires. In general, the results were similar to those of other, more aggressive techniques, and the non-inclusion of the carpometacarpal joints did not affect the final result. Conclusion: Wrist arthrodesis with fixation using Kirschner wires and an iliac bone plate, preserving the carpometacarpal joints, gives good or excellent results that are not inferior to those of other techniques that have been described. However, it presents major advantages over other methods: it is less aggressive and cheaper, and does not have the inconvenience and complications associated with the use of plates and screws.

OBJETIVO: O objetivo do presente estudo é a análise funcional e radiográfica, a longo prazo, dos pacientes com fratura do rádio distal tratados com redução fechada e fixação percutânea com fios de Kirschner. MÉTODOS: De 84 pacientes submetidos à fixação percutânea de fratura do rádio distal avaliamos 34, com tempo médio de acompanhamento de 85,7 meses com tempo mínimo de 18 meses e máximo de 168 meses. Dos 34 pacientes, 23 eram mulheres, e a idade variou de 28 a 88 anos (média de 65 anos). Foram feitas mensurações da amplitude de movimentos (ADM), força de preensão, graduação da dor e aplicação da escala funcional DASH. Além disso, medidas radiográficas foram realizadas para avaliação do tempo de consolidação e ângulos da extremidade distal do rádio. RESULTADOS: Os pacientes incluídos no estudo tiveram suas fraturas consolidadas em tempo médio de 41 dias. Os valores médios encontrados para flexão, extensão, desvio radial, desvio ulnar, pronação e supinação pós-operatórios estão dentro da zona funcional de ADM do punho. A maioria (76,5%) dos pacientes não apresentava dor na época do exame e 23 pacientes (67,6%) apresentaram um valor para o DASH igual a zero. Ocorreu uma perda de redução que foi reoperada após duas semanas de evolução e um paciente desenvolveu distrofia simpaticorreflexa associada à alteração na articulação radioulnar distal (ARUD). CONCLUSÃO: A fixação percutânea no tratamento das fraturas da extremidade distal do rádio resulta, a longo prazo, em excelente ADM, pouca ou nenhuma dor, parâmetros radiográficos aceitáveis, baixo índice de complicações além de ser um método barato e eficiente. OBJECTIVE: To evaluate, functionally and radiologically, the long term outcomes of the management of distal radius fracture treated by closed reduction and percutaneous pinning fixation. METHODS: From 84 patients submitted to percutaneous fixation of the distal radius fracture, we evaluated 34, with a medium follow-up of 85.7 months (from 18 to 168 months). Of the 34 patients, 23 were women, and the ages ranged from 28 to 88 years (median 65 years). We analyzed the range of movement, strength, pain and the results of the DASH questionnaire. Radiological evaluation was also carried out, to evaluate healing time and angles of the distal radius. RESULTS: The fractures healed in an average of 41 days. The mean values for wrist flexion, extension, radioulnar deviation, pronation and supination were within the functional parameters for ADM do punho. Most of the patients (76.5%) presented no pain during the examination, and 23 patients presented a DASH value of zero. There was one case of loss of reduction, which was re-operated two weeks after the initial surgery, and one patient developed a sympathetic dystrophy associated with a distal radioulnar joint disturbance. CONCLUSION: Percutaneous pinning fixation for distal radius fracture results in a long term follow-up with excellent range of movement, little or no pain, acceptable radiographic parameters, and low complication rate, and is an efficient and low cost method.

OBJETIVO: Artrodese do punho é uma cirurgia que deve ser sempre considerada em casos de patologias que alteram sua estrutura anatômica e funcional. Em geral os resultados são muito satisfatórios, principalmente no alívio da dor e na maioria das vezes a melhora funcional é considerável. Existem várias técnicas descritas, com variações no método de fixação interna e a maioria delas incluindo as articulações carpometacarpianas na fusão. O objetivo deste estudo é avaliar os resultados da artrodese do punho com uma técnica mais simples, mais biológica, menos dispendiosa e que não inclui as articulações carpometacarpianas. MÉTODOS: foram avaliados 15 pacientes (seis sequelas de traumatismo, quatro de artrite reumatoide, três de Kienbock grau IV, um de Preiser e um de pan-artrose). A técnica consistiu no uso de placa óssea do ilíaco e fixação com fios de Kirschner, sem incluir as articulações carpometacarpianas. RESULTADOS: A avaliação foi feita conforme o tempo de consolidação (93% em sete semanas); movimentos dos dedos e de pronossupinação; da força de pinça e preensão; avaliação funcional pelo questionário DASH, da dor e satisfação dos pacientes. Em geral, os resultados foram semelhantes aos das outras técnicas mais agressivas e a não inclusão das articulações carpometacarpianas na artrodese não afetou o resultado final. CONCLUSÃO: A artrodese do punho com fixação através de fios de Kirschner e uso de placa óssea do ilíaco preservando as articulações carpometacarpianas dá resultado bom ou excelente, não inferior ao de outras técnicas descritas. Apresenta, porém uma grande vantagem sobre as demais: é menos agressiva, mais barata e não apresenta os inconvenientes do uso de placas e parafusos sujeitos a maiores complicações OBJECTIVE: Wrist arthrodesis is a surgical procedure that should always be considered in pathologies where there is alteration of the anatomical and functional structures. In general, the results are very satisfactory, particularly for pain relief, and in the majority of cases, there is considerable functional improvement. Various techniques are described, with different methods of internal fixation, most of which include the carpometacarpal joints (CMJ) in the fusion. The objective of this study is to evaluate the results of wrist arthrodesis through a technique which is simpler, more biological, more inexpensive, and does not involve the carpometacarpal joints. METHODS: 15 patients with wrist arthrodesis were evaluated (6 with sequelae of trauma, 4 Rheumatoid Arthritis, 3 Kienbock's grade IV, 1 Preiser and 1 panarthrosis). The technique consisted of the use of an iliac bone plate and internal fixation with Kirschner wires, avoiding the carpometacarpal joints. RESULTS: The evaluation was based on consolidation time (93% in 7 weeks); movements of the fingers and pronosupination; pinch and grasp strength; functional evaluation through the DASH questionnaire, pain and patient satisfaction. In general, the results were similar to those of other, more aggressive techniques, and the non-inclusion of the carpometacarpal joints did not affect the final result. CONCLUSION: wrist arthrodesis with fixation using Kirschner wires and the use of an iliac bone plate, preserving the carpometacarpal joints, gives good or excellent results which are similar to those of other techniques described. However it presents major advantages over other methods: it is less aggressive, less expensive, and does not have the inconvenience and complications associated the use of plates and screws.