Reparación artroscópica de las luxaciones acromioclaviculares
Trabajo realizado por la Unidad de Cirugía del Hombro del Hospital Morales Meseguer (Dr. Diego José Giménez Belmonte, Dr. Juan Francisco Abellán Guillén, Dr. Eduardo Melendreras Montesinos)
Arthroscopic acromioclavicular dislocation treatment using flexor carpi radialis autograft.
Abellan Guillen J.F.1, Gimenez Belmonte D.1, Melendreras Montesinos E.1, Martinez-Martinez J.1, Andrés-Grau J.1, Arroyo F.F., Hospital Morales Meseguer, Orthopedic Surgery, Murcia, Spain
Standard method for treating Acromioclavicular (AC) injuries is still lacking, with a lot of different surgical reconstruction techniques described. The purpose of this study is to describe the details of our surgical technique and to present the obtained clinical results.
We have recorded patients who presented acromioclavicular (AC) joint dislocation and underwent surgical treatment. Seven patients aged 18 to 45 were treated. They presented chronic Rockwood type III AC injury. They underwent arthroscopically assisted stabilization of AC dislocation using a double-strand flexor carpi radialis (FCR) allograft. In 2 of the cases distal clavicle was resected. The graft was secured with the AC GraftRope System (Arthrex, Naples, FL). The metal clavicle washer and coracoid button are joined by a continuous loop of number 5 FiberWire, providing fixation during the healing phase.
Range of motion was full and not painful in all the patients 3 months after the surgical procedure. One of the patients presented loss of reduction, but without clinical relevance. No major complications were seen. Two of the patiens resented wound dehiscence because intolerance to system suture. They both healed with conventional daily dressing. At final follow-up of 1 year all patients remain asymptomatic and with no limitations to daily activities, including sports. No symptoms or loss of strenght related to donor site were seen.
Acromioclavicular joint reconstructions with tendon grafts have shown substantial improvement in initial stability and a load-to-failure equivalent to the intact coracoclavicular ligaments. Tendons from semitendinosus, gracilis, tibialis or peroneus brevis muscles, have been proposed as graft donor site. We describe the use of FCR autograft for coracoclavicular ligament reconstruction.
The GraftRope system (Arthrex, Naples, FL) allows achieving anatomic reduction and securing fixation. With an arthroscopically assisted approach the graft can be securely fixed. Our results show good results and no morbidity of the donor site using FCR autograft.
Tratamiento del dolor persistente de hombro con inyección subacromial de ácido hialurónico.
Trabajo realizado por la Unidad de Cirugía del Hombro del Hospital Morales Meseguer (Dr. Juan Francisco Abellán Guillén, Dr. Diego José Giménez Belmonte, Dr. Eduardo Melendreras Montesinos, Dra. Guadalupe Ruiz Merino y Dra. Mª Angeles Moreno Carrillo)
Trabajo ganador del segundo premio en la VIII Edición del Premio Nacional de Investigación “Pedro Guillén”
de Traumatología del Deporte organizada por la Cátedra de Traumatología del Deporte de la Universidad Católica San Antonio de Murcia (UCAM)
Poster presented at the 14 ESSKA Congress. Oslo 2010.
Treatment of persistent shoulder pain with subacromial sodium hyaluronate injection. Preliminary results of a randomized controlled trial.
Abellan Guillen J.F.1, Gimenez Belmonte D.1, Melendreras Montesinos E.1, Ruiz Merino G.2, Moreno Carrillo A.3, Gil E.1, Peñalver F.1
1Hospital Morales Meseguer, Orthopedic Surgery, Murcia, Spain, 2Fundación para la Formación Sanitaria, Murcia, Spain, 3Hospital Morales Meseguer, Department of Rehabilitation, Murcia, Spain
Persistent shoulder pain is a highly prevalent problem that is frequently associated with limited range of motion and decreased function. The
purpose of this study is to evaluate the effect of subacromial injections of sodium hyaluronate in patients with pain shoulder, clinical subacromial impingement, and no rotator cuff tear.
This was a randomized, double-blind (blinded observer), corticoid controlled study. It was designed to evaluate the efficacy of subacromial sodium hyaluronate injection in patients with persistent shoulder pain. Twenty patients were included in the study. They were randomized into two treatment groups receiving both a single subacromial injection, either corticoid solution (1cc triamcinolone acetonide + 1cc mepivacaine), or sodium hyaluronate (2cc). Patients were evaluated at baseline and at 1, 3 and 6 months. Demographic data were registered before stating the study. Entity of pain was evaluated with the use of the Visual Analogue Scale (VAS). Functional assessment was performed according to the Constant Score.
The demographic characteristics were similar in the two treatment groups. At baseline mean EVA was 6.29 (SD 1.54) and mean Constant score was 66.17 (SD 17.9). Both groups showed significant reduction from baseline in the VAS and an increase in his functional score whithin the first month. No significant changes were seen between first month and neither 3 nor 6 month assessment.
These results show that Sodium Hyaluronate subacromial injections are an effective treatment option in patients with persistent shoulder pain and no rotator cuff tear. Compare to corticoid injection have shown same results at medium term follow-up. However, sodium hyaluronate injections can prevent the occurrence of corticoids-related complication, such as local degradation of tissues, tendon tearing, or arthropathy. Most of the improvent in functional score and pain relief is seen in the first 4 weeks, after that no significant changes are shown.
Intrathoracic fracture-dislocation of the humeral head: a case report.
Abellan JF; Melendreras E; Gimenez DJ; Carrillo FJ; Ruano L; Rivkin J. Hospital Morales Meseguer, Murcia, Spain. Journal of Orthopaedic surgery 2010;18(2):254-7.
Fracture-dislocation of the humeral head into the thoracic cavity is a rare injury. We present one such case in a 70-year-old woman. she presented with a 4-parth fracture-dislocation of the proximal humerus, with displacement of the humeral head into the thoracic cavity. She had no signs of acute distress or hemodynamic instability. She underwent hemiarthroplasty of the right shoulder, but the humeral head fragment could not be removed. At 27-month follow-up, the patient had limited mobility of her right shoulder due to axilary nerve palsy but no pain or intrathoracic complications. In the absence of intrathoracic complications, the removal of the humeral head may not necessary.