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DOI: 10.1055/s-0037-1606676
Técnica para el tratamiento de la malunión intra-articular del radio mediante osteotomías con control artroscópico
Correction of malunited itra-articular distal radius fractures with an inside-out osteotomy techniquePublication History
Publication Date:
13 September 2017 (online)
El propósito de este trabajo es presentar un método para realizar las osteotomías intraarticulares con control visual.
Método: Utilizamos los abordajes dorsales clásicos de artroscopia (3-4, 6-R) además de un portal volar radial (VR). Para visualizar la articulación radiocarpiana recurrimos sólo a la tracción sin irrigar con agua. Las osteotomías se efectuaron con osteotomos de 4 mm introducidos por los portales y bajo control visual por la óptica del artroscopio. Una vez finalizada la refractura se movilizaron y fijaron los fragmentos desplazadas mediante tornillos o placas, obteniendo en todos los casos escalones próximos a 0mm.
Conclusiones: Este procedimiento permite realizar la partición de los fragmentos por los trazos originales de fractura. La clave de esta intervención es realizar la artroscopia sin agua (técnica seca) que permite una visión nítida y la ejecución de las osteotomías sin extravasación de agua, ni pérdidas de visión.
Purpose: To present a method to correct intra-articular malunion with an inside-out osteotomy technique under arthroscopic guidance.
Method: The joint is explored with a 2.7 mm arthroscope through the standard portals without infusing any water. To allow room to introduce the curettes and the osteotomes (4 mm wide), instrumentation portals are made slightly larger than usual. Malunited fragments are cut with the osteotomes from inside the joint and advanced out. Fragments are mobilized and granulating tissue and/or new bone is removed with curettes and synoviotomes. Following disimpaction and reduction, fixation with plates or screws, via the appropriate open approach, is carried out under arthroscopic control. No water is used throughout the procedure except at the end of the operation to clear out debris.
Results: Steps were corrected to 0 mm in all cases. Gaps of less than 1 mm were common.
Conclusions: The procedure allows us to define each cartilage containing fragment and to recreate the original articular fracture line without the fear of creating new fracture lines in the articular surface. The technique can be used in case of irregularly defined fragments not amenable to classic techniques. The key of the procedure is to carry out the arthroscopic exploration without water infusion (Dry technique).