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Resumen Introduccion La artroplastia total de codo es una opcion disponible para el tratamiento de diversas patologias del codo. Ademas de la indicacion clasica en la artritis reumatoide, han surgido nuevas indicaciones en fracturas y pseudoartrosis de humero distal. Sin embargo, no es una tecnica exenta de complicaciones. La rotura del aparato extensor es una de ellas. Caso clinico Mujer de 61 anos con fractura conminuta no consolidada supraintercondilea de humero distal, en un codo con afectacion severa por artritis reumatoide, es tratada mediante artroplastia total semiconstrenida de codo tipo Coonrad Morrey. Al mes postoperatorio desarrollo una osificacion en el triceps distal que se extirpo. Varios meses despues presenta una lesion del aparato extensor que fue tratada mediante sutura directa. Conclusion Para casos seleccionados, el empleo de protesis totales de codo ofrece resultados alentadores. Una correcta indicacion y una buena tecnica quirurgica son indispensables para obtener resultados satisfactorios y minimizar la aparicion de complicaciones.

Introduction Total elbow arthroplasty is an available option for the treatment of many pathologies of the elbow. Apart from the classic indication in rheumatoid arthritis, new indications have arisen in fractures and non-unions of the distal part of the humerus. Many complications have been described with the use of this technique. Extensor mechanism rupture is one of them. Case report We present the case of a 61-year-old woman with a nonunited comminuted distal humerus fracture in a severely affected rheumatoid elbow who was treated with a Coonrad-Morrey semiconstrained total elbow arthroplasty. One month after the operation she developed a palpable ossification in distal triceps which was extirpated. Some months later she presented an extensor mechanism rupture which was surgically treated using a direct suture. Conclusions In selected cases, the use of total elbow prosthesis is related to good results. A correct indication and a meticulous surgical technique are essential in order to obtain satisfactory results and to minimise the risk of complications.

Objetivos. La rotura distal del tendon del biceps braquial es una lesion poco frecuente. El objetivo de nuestro estudio es evaluar los resultados de las roturas distales de dicho tendon, intervenido quirurgicamente por via anterior entre noviembre de 1998 y diciembre de 2003. Material y metodo. Estudio retrospectivo con 12 pacientes y 13 lesiones, con un seguimiento medio de 37 meses (12-60). La edad media fue de 37,6 anos, y todos los pacientes eran del sexo masculino. Todas las lesiones se localizaron en el brazo dominante, excepto un caso de rotura bilateral. Todos fueron intervenidos a traves de un abordaje anterior. Diez lesiones (76,9%) se suturaron con arpones, dos (15,4%) con tuneles oseos y una (7,7%) se suturo con un anclaje con endobutton. Todos los pacientes, excepto uno, fueron inmovilizados con una ferula de escayola braquioantebraquial posterior durante las dos primeras semanas postoperatorias. En cinco pacientes se continuo con esta inmovilizacion y en seis se sustituyo por una ortesis articulada. Resultados. Se evaluaron los parametros de: movilidad, fuerza, dolor y satisfaccion personal. Todos los pacientes presentaron una movilidad completa. Once pacientes (91,6%) recuperaron la fuerza totalmente. Como complicaciones se encontro una paresia transitoria del nervio radial. La satisfaccion personal fue excelente en once pacientes (91,6%) y buena en un paciente (8,4%). No existio ninguna nueva re-ruptura. Conclusiones. Los resultados clinicos y funcionales han sido en la mayoria de los pacientes excelentes, por lo que se recomienda la sutura con arpones por via anterior. Palabras clave: rotura, tendon distal del biceps, via anterior, arpones.

Purpose Distal ruptures of the brachial biceps tendon are an infrequent injury. The purpose of this paper is to assess the outcome of distal ruptures of the tendon addressed surgically through an anterior approach between November 1998 and December 2003. Materials and methods Retrospective study of 12 patients and 13 injuries with a mean follow-up of 37 months (range: 12-60). Mean age was 37.6 years and all patients were male. All injuries were located in the dominant arm, except for one case in which the rupture was bilateral. All were operated with an anterior approach. In ten injuries (76.9%) harpoon sutures were used, in two (15.4%) bone tunnels and in one instance (7.7%) an endobutton anchor. All patients but one were immobilized with a brachioantebrachial plaster splint during the first two weeks post-op. In five patients, this immobilization was continued, whereas in four it was replaced by an articulated brace. Results Range of movement, strength, pain and personal satisfaction were the parameters assessed. All patients had full mobility. Eleven patients (91.6%) recovered their full strength. As far as complications are concerned, we had a transient radial nerve palsy. Personal satisfaction was excellent in eleven patients (91.6%) and good in one (8.4%). There was no re-rupture. Conclusions Our clinical and functional results are excellent, for which reason we recommend harpoon suturing with an anterior approach.

Resumen Presentamos el caso clinico de un paciente de 53 anos, con osteonecrosis importante sin colapso en el condilo femoral interno de la rodilla izquierda, fumador y bebedor importante, ademas de diabetico tipo 2. Se le practica una tecnica de trapdoor en el condilo femoral interno de la rodilla, con una mejoria sintomatica y sin colapso articular a los 45 meses despues de la cirugia.

We present a clinical case of a 53 year-old patient with significant osteonecrosis without collapse, in the internal femoral head of the left knee, a significant smoker and drinker, as well as having type 2 diabetes. The trapdoor technique was on the internal femoral head of the knee, with an improvement in the symptoms and without collapse of the joint 45 months after surgery.