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Resumen Introducción: Los métodos más utilizados para la artrodesis de la articulación interfalángica proximal y metacarpofalángica son la banda de tensión y el tornillo compresivo. El objetivo de este estudio fue comparar los resultados entre pacientes tratados con estas técnicas. Materiales y Métodos: Estudio comparativo retrospectivo de 10 años. Se incluyeron pacientes esqueléticamente maduros tratados por artrosis y artritis. Se analizaron la tasa de consolidación ósea, el tiempo hasta la consolidación, la incidencia de complicaciones y la tasa de reoperaciones. En un análisis secundario, se compararon los pacientes reumáticos y no reumáticos. Resultados: Se evaluaron 56 casos en 44 pacientes (edad promedio 53 años). Grupo 1: 35 casos tratados con banda de tensión y grupo 2: 21 tratados con tornillo compresivo. Había 32 casos reumáticos y 24 no reumáticos. El seguimiento promedio fue de 24 meses. La tasa promedio de consolidación fue del 94,2% en el grupo 1 y del 85,7% en el grupo 2. La incidencia de complicaciones fue del 11,4% en el primer grupo y 23,8% en el segundo, y la tasa de reoperaciones, del 17,1% y del 0%, respectivamente. Conclusiones: Ambos métodos permiten lograr tasas altas de consolidación, pero la incidencia de seudoartrosis fue casi tres veces superior con el tornillo compresivo que con la banda de tensión. La tasa más alta de reoperaciones en el grupo con banda de tensión fue por extracción del material. El tiempo de consolidación fue más corto en los pacientes no reumáticos, independientemente de la técnica. Palabras clave: Artrodesis; fusión interfalángica proximal y metacarpofalángica; banda de tensión; tornillo compresivo. Nivel de Evidencia: III

Objetivo: Comunicar la eficacia del clavo endomedular recubierto con antibiótico (CERA) para erradicar la infección en la seudoartrosis infectada de húmero (SIH).Materiales y Métodos: Once pacientes (edad promedio 48 años). El tiempo entre la fractura y la cirugía fue 25 meses. El CERA se impregnó con vancomicina en 9 pacientes. El seguimiento promedio fue de 54 meses.Resultados: Se aisló S. aureus resistente a meticilina (SARM) en 5 pacientes. Todos recibieron antibióticos sistémicos por 7 semanas. El antibiótico más utilizado fue vancomicina. La mediana entre el primer tiempo quirúrgico y la reconstrucción fue 56 días (RIC 47-98). Luego del desbridamiento quirúrgico del primer tiempo, se midió el defecto óseo remanente y se lo dividió con variables dicotómicas: grupo con defectos

Introduction The anterolateral thigh free flap is currently one of the most useful reconstructive options. A long pedicle with suitable vessel diameter, reliable anatomy and the availability of different tissues with large amounts of skin make this flap versatile. The purpose of this study was to evaluate the flap versatility in a series of patients with coverage defects in both, the upper and lower limbs. Methods A retrospective study was performed. Inclusion criteria were patients with defects in the extremities to whom this flap was made as a reconstructive treatment. Preoperative, intraoperative and postoperative variables were analyzed. Results Twelve patients (7 men and 5 women) with an average age of 44 years were included. Defects were caused by oncological resection (9 patients) and trauma (3 cases). In 4 cases the defect was in the upper extremity and in 8 cases in the lower extremity. The average time between the defect and the reconstructive surgery was 8 days. The survival rate of the flap was 92%, with only one failure. Donor site presented no complications and primary closure was performed in all cases, except for two requiring closure with skin graft. Conclusions Anterolateral thigh free flap is a valid and very useful resource for coverage of defect of different etiologies in the upper and lower limbs since its versatility allows its successful adaptation in defects of varied location and size.

Introduction: The anterolateral thigh free flap was expanded to establish itself as one of the most useful options for the reconstruction of defects in different locations. We present our experience with free ALT flap for functional coverage of different upper and lower limb defects. Methods: Retrospective study of cases of reconstruction in a period of 6 years. In the preoperative period, demographic variables, causes of the defect, size and location of the defect and time between the defect and surgery were analyzed. From the surgical technique, the type of anastomosis performed and the type of closure of the donor site were analyzed. Finally, during the postoperative period, the survival of the flaps and the complications of the flap and the donor site were evaluated. Results: We included 7 men and 5 women with an average age of 44 years. The defects were caused by oncological resection in 9 patients and by trauma in 3. The defect was in the upper limb in 4 cases and 8 in the lower limb. The size of the flap varied from 6 to 20 cm in length and from 3 to 12 cm in width. The survival rate of the flap was 92%, presenting failure only in one case. The donor site presented no complications. Conclusion: The anterolateral thigh free flap is a useful resource for the coverage of defects of different etiologies both in the upper limbs and in the lower limbs since its versatility allows it to adapt successfully in varied defects.

Introduction: Reconstruction of the elbow with restoration of function can be challenging, particularly with large osseous defects created from tumor resection or trauma. Osteoarticular allograft reconstruction is an option in patients with massive periarticular elbow bone loss secondary to tumor surgery or trauma. Surgical reconstruction of a posttraumatic elbow with extensive bone loss remains a challenging problem. The clinical success with osteoarticular allograft reconstruction has been documented in several series of oncological limb salvage surgery; but reports of using hemiarticular elbow allografts in the reconstruction of postraumatic elbows are few. Objective: To present a clinical case of a 46-year-old female patient with open (Gustilo 1) Arbeitsgemeinschaft für Osteosynthesefragen (AO) type C3 fracture of the distal humerus after high-energy trauma, treated operatively with the use of osteoarticular allograft to restore posttraumatic articular defects and massive bone loss, and to perform a bibliographic review. Materials and Methods: We report our experience with hemiarticular elbow allograft reconstructions after severe elbow trauma in a young patient, as first treatment. An extensive resection of distal humerus was performed through a posterior approach with Chevron osteotomy. The defect was reconstructed with distal humerus osteoarticular allograft with a stable internal fixation with compression plates and screws. Patient’s epicondyles with collateral ligaments and tendon insertions were carefully preserved and fixed with mini-screws. The ulnar nerve was transposed anteriorly. Results: At a follow-up of 30 months, the arc of motion was 120° and the rotational arc of motion was 100°, without clinical complications. The Mayo Elbow Performance Score and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire, used to assess clinical outcomes and patient satisfaction, were satisfactory. Radiographic results demonstrated radiographic incorporation of the allograft with the maintenance of the joint congruity. Conclusions: Management of a posttraumatic elbow injury with significant articular defects and deficient bone can pose a major reconstructive challenge and is especially concerning given the increased frequency of such injuries as a result of an escalating rate of high-energy trauma among young adults. Large bone allograft transplants have been successfully used to reconstruct skeletal defects created by tumor resections and failed arthroplasties, but little has been reported on their use in traumatic defects. The reconstruction of distal humerus with osteoarticular allograft respecting the autogenous collateral ligaments is a viable alternative in salvage situations involving massive bone loss and young patients who are not conventional candidates for total elbow arthroplasty. The preservation of collateral ligaments in conjunction with tendon insertions, at the short-term observation, may improve elbow stability. This study suggests that large bone allografts are of value in reconstructing traumatic skeletal defects, especially those involving an articular surface in a young patient. However, long-term results are still unknown. Although not recommended for routine use, this operation is viewed as a salvage procedure.