Bloqueo óseo metafisario de radio y fijación estable en seudoartrosis de polo proximal de escafoides sin necrosis. [Radial metaphyseal core decompression and stable fixation of proximal pole scaphoid nonunion without osteonecrosis ]

Ignacio Rellán, Gerardo Luis Gallucci, Jorge Guillermo Boretto, Agustín Donndorff, Ezequiel Ernesto Zaidenberg, Pablo De Carli

Resumen


Objetivo: Reportar la tasa de consolidación y los resultados de una serie de 22 pacientes con seudoartrosis del polo proximal del escafoides tratados con un bloqueo óseo metafisario asociado a un tornillo autocompresivo anterógrado.

Materiales y Métodos: Serie prospectiva de pacientes con seudoartrosis del polo proximal del escafoides en quienes se constató un sangrado intraoperatorio en ambos fragmentos. Se excluyó a los pacientes con desplazamiento, cambios degenerativos, fragmentación del polo proximal, cavitación del foco, pérdida de altura, necrosis y aquellos con inestabilidad carpiana. Se tomaron radiografías e imágenes por tomografía computarizada para evaluar su consolidación; se registraron la movilidad y la fuerza de puño, y los pacientes completaron una escala analógica visual para dolor en reposo, dolor en actividad, estado subjetivo funcional y el cuestionario DASH.

Resultados: La serie incluyó 18 pacientes. Diecisiete presentaron consolidación. El seguimiento promedio fue de 22 meses y la movilidad final promedio fue: flexión 87%, extensión 84%, desviación radial 78%, desviación cubital 84% y fuerza de puño 85%. El puntaje promedio de la escala analógica visual fue 0 para dolor en reposo; 2, para dolor en actividad y 9 para función, en tanto que el puntaje DASH promedio fue de 8.

Conclusiones: Con esta técnica confiable y sencilla, obtuvimos una tasa de consolidación del 95% y un muy buen resultado funcional. El bloqueo óseo metafisario asociado a un tornillo anterógrado constituye una alternativa válida y eficaz para tratar la seudoartrosis del polo proximal del escafoides, vital en pacientes cuidadosamente seleccionados.

 

ABSTRACT


Objective: To report the consolidation rate and the outcomes of a series of 22 patients
with proximal pole scaphoid nonunion treated with a metaphyseal core decompression
and an anterograde self-compressing screw.


Methods: We present a prospective series of patients with proximal pole scaphoid
nonunion and confirmation of intraoperative bleeding in both fragments. Patients
presenting with displacement, degenerative changes, proximal pole fragmentation,
cavitation at the fracture site, reduced bone length, and necrosis, as well as those with
carpal instability, were excluded. X-rays and computed tomography scans were
performed to assess consolidation; range of motion and grip strength were recorded, and
patients completed a visual analogue scale for pain at rest, pain during activity, and
subjective functional status, as well as a DASH (Disabilities of the Arm, Shoulder and
Hand) questionnaire.


Results: Eighteen patients were included. Union was observed in 17 patients. The
average follow-up time was 22 months, and the average final range of motion was as
follows: 87% for flexion, 84% for extension, 78% for radial deviation, 84% for ulnar
deviation, and 85% for grip strength. The average score on the visual analogue scale
was 0 for pain at rest, 2 for pain during activity, and 9 for function, while the average
DASH score was 8.


Conclusions: Using this simple and reliable technique, we obtained a 95% union and
very good functional results. Metaphyseal core decompression with an antegrade screw
is a valid and effective alternative for treatment of proximal pole scaphoid nonunion in
carefully selected patients.


Palabras clave


Escafoides; polo proximal; seudoartrosis; Scaphoid; proximal pole: nonunion.

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DOI: http://dx.doi.org/10.15417/issn.1852-7434.2019.84.1.786

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Registro de la Propiedad Intelectual Nº 22171081 (en línea).

ISSN 1852-7434 (en línea).

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