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Resumen: Introducción: El dispositivo de fijación interna Internal Joint Stabilizer of the Elbow (IJS-E) se ha planteado recientemente como una alternativa válida a la fijación externa y/o transarticular en la adyuvancia del tratamiento quirúrgico de la inestabilidad aguda compleja persistente de codo tras una correcta reparación osteoligamentosa. Material y métodos: Presentamos un estudio retrospectivo de una serie de casos tratados con IJS-E System (Skeletal DynamicsR) entre febrero del 2019 y 2020. Como criterio de inclusión se establece: pacientes mayores de 18 años con inestabilidad aguda de codo persistente tras una correcta reparación osteoligamentosa, tratados con fijador interno IJS-E. Resultados: Se incluyeron cinco pacientes en el estudio (cuatro varones y una mujer) con una edad media de 37,4 años (24 a 71 años). El patrón lesional fue el de inestabilidad pósterolateral, triada terrible de codo (TTIE), en todos los casos. El seguimiento medio total fue de 9,8 meses (seis a 12 meses). La puntuación Disabilities of the Arm Shoulder and Hand (DASH) media fue de 11,78 (4,2 a 20,6) y la puntuación Mayo Elbow Performance (MEP) media fue de 94 puntos (85 a 100). Se obtuvo un arco de movilidad final de 134°. El porcentaje de reintervención fue del 100% debido a la realización de movilización bajo anestesia asociada a extracción programada del dispositivo. Como complicaciones identificamos un caso de osificación heterotópica y uno de rigidez que requirió artrolisis abierta. En ninguno de los casos se objetivó durante el seguimiento pérdida de congruencia articular ni otras complicaciones mayores. Conclusiones: Nuestra serie de casos presenta unos resultados funcionales y radiológicos prometedores mediante el empleo del IJS-E como alternativa a la fijación externa. Abstract: Introduction: Treatment of acute complex fracture-dislocation of the elbow has been associated with a high rate of complications. Internal Joint Stabilizer of the Elbow (IJSE) device appears as a valid option to optimize and improve our results. Material and methods: We present a retrospective case series of five patients treated at our institution with IJS-E System (Skeletal DynamicsR) from February 2019 to 2020. Our inclusion criteria was: patients over 18 years old surgically treated with IJS-E due to persistent elbow instability despite of a suitable osteoligamentous surgical repair. Results: We obtained a total of five patients (4 males and 1 female) with an average age of 37.4 years old (24-71). The Injury pattern was posterolateral instability, TTIE in all cases. The mean final postoperative MEP score was 94 points (85-100) and the postoperative DASH score was 11.78 points (4.2-20.6) with an average follow-up of 9.8 months (6-12). We described a final arc of motion of 134° with a range of flexionbetween 120° and 140° and a mean lack of extension of 12° (5°-20°), with a complete arc of pronosupination. As complications we found one case of heterotopic ossfication and one case of elbow stiffnes. However, no complications device-related or articular incongruence were reported during follow-up. Conclusions: The IJS-E device appears as an effective alternative instead of external fixation. Nevertheless, a high rate of reoperation up to 100% is associated with IJS-E. A larger series, longer follow-up and prospective studies are needed to define properly his role in the surgical treatment of acute elbow instability.

The aim of the present study is to describe in detail the morphology and innervation pattern of the anconeus muscle, bearing in mind clinical implications such as iatrogenic injuries during surgical elbow approaches. A cadaveric study was performed; 56 elbows from 28 formalin-fixed cadavers belonging to the Anatomy Department of Universidad Complutense of Madrid were dissected. The triceps–anconeus nerve was located and dissected. A second innervation to the anconeus muscle from a branch of the posterior interosseous nerve (PIN) was occasionally detected. Taking the lateral epicondyle as a landmark, the entry points of both nerves in the muscle were referenced, the triceps–anconeus nerve was referenced at 0°, 30°, 45°, 70° and 90° of elbow flexion, and the PIN branch at 0°. Anconeus muscle was present in all specimens. The triceps–anconeus nerve was present in all of the dissected elbows. A branch from PIN to the anconeus muscle was present in 38 of the 54 elbows (70.4%). There were statistically significant differences in all measurements regarding the specimens’ gender, being higher for men. There is evidence of a high frequency of a double innervation pattern for the anconeus muscle: the main branch of triceps–anconeus muscle depending on the radial nerve, which is liable to being damaged during posterior elbow approaches, and a secondary branch depending on the PIN. There are very few references to this finding in Anatomical literature and none with such a large sample size.

Introducción. La necrosis avascular (NAV) del hueso grande es una enfermedad rara y de etiología desconocida que suele aparecer en personas jóvenes y causa dolor crónico e impotencia funcional en la muñeca. Existen múltiples tratamientos para esta patología; sin embargo, actualmente no hay un consenso claro sobre las indicaciones de estas técnicas. Presentación del caso. Mujer de 27 años quien asistió al Servicio de Cirugía Ortopédica y Traumatología de una institución de tercer nivel de atención por dolor en la muñeca izquierda que comenzó ocho meses atrás. Como único antecedente de importancia, había presentado un golpe en el área. En la radiografía que presentó la paciente no se encontraron alteraciones. Se ordenó resonancia magnética nuclear (RMN) que mostró fractura trabecular extensa del hueso grande con signos de pseudoartrosis y edema óseo, por lo que se inició manejo conservador. En la RMN de control, realizada un año después, se observó persistencia de edema óseo, por lo que se sospechó NAV del hueso grande y se realizó tomografía axial computarizada que confirmó el diagnóstico. La paciente fue tratada mediante resección artroscópica del polo proximal del hueso grande con buenos resultados a corto plazo. Conclusión. Es necesario realizar nuevos estudios con resultados a largo plazo y que comparen las diferentes opciones terapéuticas para esclarecer el mejor tratamiento de esta rara enfermedad.

Introduction Nonunion of the distal radius is an extremely rare and serious complication with unpredictable outcomes. The aim of the present study is to analyze the radiological and functional results after a protocolized surgical treatment. Material and Methods A retrospective review of case series of patients with diagnosis of nonunion of the distal radius surgically treated from 2010 to 2016. The diagnosis of nonunion was made at 6 months without signs of consolidation. According to computed tomography (CT) scan images, we propose a classification of this complication as type I: no deformity or mild deformity, with subchondral metaphyseal bone stock beneath lunate facet greater than 10 mm, with no degenerative changes at the distal radioulnar joint (DRUJ); type II: moderate deformity or degenerative changes in the DRUJ, distinguishing between IIA and IIB based on the subchondral metaphyseal bone stock; and type III: degenerative changes at the midcarpal joint. In all cases, a reconstructive technique consisting of volar locking plate osteosynthesis with autologous tailored iliac crest graft was performed, hence none of the cases were classified as type III. Results In total, six cases were included. Mean follow-up: 58 months (range: 30–108 months). Consolidation was achieved in a mean period of 5 months (range: 3–9 months). Average active range of motion: flexion: 54° (range: 10°–80°); extension: 40° (range: 10°–85°); supination: 82.5° (range: 75°–85°); pronation 80° (range: 55–85°); radial deviation: 15° (range: 5°–20°); and ulnar deviation 15° (range: 5–20°). Mean strength: 24.15 Kg (6.9–35 Kg). The average score on the Visual Analog Scale (VAS) at rest was of 0.6 (0–2), and with movement, it was of 1.8 (0–4). The mean postoperative score on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was of 18.48 (range: 0–50.8). Average radial height: 9.65 mm (range: 7–12 mm); average radial angulation: 17° (10°–20°); volar tilt: 8.36° (range: 0.2°–21°); average ulnar variance: 1.52 mm (range: 0–3.5 mm). Complications: persistent nonunion, superficial wound infection, acquired residual ulnar club hand deformity, radiocarpal arthritis, and midcarpal arthritis. Nevertheless, no salvage techniques were needed or requested during the follow-up, with all patients in an active work situation or living an active life in complete normality. Conclusions The protocolized surgical treatment of pseudoarthrosis of the the distal radius, based on our proposed classification, offers good functional outcomes in the long-term follow-up.

Introduction Traumatic pathology continues to represent an important socio-health problem. The aim of the study was to assess the clinical predictors of total expenditure, as well as to analyse which components of the cost are modified with each clinical parameter of the polytraumatized patient. Material and methods Retrospective study of 131 polytrauma patients registered prospectively. A statistical analysis was carried out to assess the relationship between clinical parameters, the total cost and the cost of various treatment components. Results The total cost of hospital admission was 3,791,879 euros. The average cost per patient was €28,945. Age and gender were not predictors of cost. The scales ISS, NISS and PS were predictors of the total cost and of multiple treatment components. The AIS of Skull and Thorax predicted a higher cost of admission to ICU and Total Cost. The AIS of lower limbs was associated with greater spending on facets of treatment related to surgical activity. Discussion There are clinical parameters that are predictors of the treatment cost of the polytraumatized patient. The study describes how the type of trauma that the patient suffers modifies the type of expenses that will present in their hospital admission. Conclusions Polytraumatized patients with severe multisystem injury present increased costs in multiple components of the treatment cost. Patients with TBI or chest trauma present a higher cost for admission to ICU and those with orthopaedic trauma are associated with greater expenditure on surgical activity.

Resumen Introduccion La enfermedad traumatica continua representando un importante problema socio-sanitario. El objetivo del estudio es valorar predictores clinicos del gasto total, asi como analizar que componentes del coste se modifican con cada parametro clinico del politraumatizado. Material y metodos Estudio retrospectivo de 131 politraumatizados registrados prospectivamente. Se llevo a cabo un analisis estadistico para valorar la relacion entre parametros clinicos, el coste total y el coste de los principales componentes del tratamiento. Resultados El coste total del ingreso hospitalario fue de 3.791.879 euros. El gasto medio por paciente fue de 28.945 €. La edad y el genero no fueron predictores del coste. Las escalas ISS, NISS y PS fueron predictores del coste total y del coste de diferentes facetas del tratamiento. El AIS de craneo y torax predijo un mayor coste de ingreso en UCI y de coste total. El AIS de miembros inferiores se asocio exclusivamente a un mayor gasto en las facetas de tratamiento relacionadas con la actividad quirurgica. Discusion Existen parametros clinicos que son predictores del coste de tratamiento del paciente politraumatizado. En el estudio se describe como el tipo de traumatismo que presenta el paciente modifica el tipo de gastos que presentara en su ingreso hospitalario. Conclusiones Los pacientes politraumatizados que presentan lesion multisistemica grave presentan incremento del gasto en multiples componentes del coste de tratamiento. Los pacientes donde predomina el TCE o traumatismo toracico presentan un mayor coste por ingreso en la UCI y los que predomina el traumatismo ortopedico asocian un mayor gasto en actividad quirurgica.

Carpal coalitions are relatively frequent between bones in the same carpal row. Coalitions between bones of different rows, however, are very uncommon. We present a case of bilateral intercarpal coalition between the trapezium and scaphoid as an incidental finding, confirming its hereditary origin since a parent has the same bilateral coalition.

Resumen Las coaliciones carpianas son relativamente frecuentes entre huesos de la misma hilera del carpo. Son mucho mas infrecuentes las coaliciones entre huesos de diferente hilera. Presentamos un caso de coalicion intercarpiana entre trapecio y escafoides bilateral como hallazgo casual, confirmando su origen hereditario ya que uno de los progenitores presenta la misma coalicion.

The goal of the present study was to analyze a modified American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, time to union, and the incidence of fusion after isolated arthroscopic posterior subtalar arthrodesis using either 1 or 2 screws of different diameters. We reviewed a consecutive series of 65 patients, mean age 50.0 ± 15.6 years, including 38 males (58.5%) and 27 females (41.5%), who had undergone arthrodesis from May 2004 to February 2011. The mean follow-up duration was 57.5 (range 24 to 105) months. The patients were divided into 3 groups according to the fixation method used: group 1 (n = 12; 18.5%) underwent fixation with one 6.5-mm screw; group 2 (n = 40; 61.5%) with one 7.3-mm screw; and group 3 (n = 13; 20%) with two 7.3-mm screws. An overall statistically significant (p

Symptomatic posttraumatic arthritis of the elbow in young patients is a disorder for which there is currently no satisfactory solution. In this case report we show the evolution of a comminuted fracture of the capitellum with trochlear extension (McKee typeIV) treated initially with open reduction and internal fixation that eventually required a resurfacing hemiarthroplasty of the capitellum and reconstruction of the lateral ligament complex. After this surgical procedure, the patient had evident improvement of pain and of elbow range of motion, keeping the possibility of performing other rescue techniques open if they were to be necessary in the future.

Resumen El tratamiento de la artrosis postraumatica sintomatica del codo en el paciente adulto joven supone una patologia que no tiene una solucion satisfactoria en la actualidad. Presentamos en este caso clinico la evolucion de una fractura conminuta del capitellum con extension a la troclea (tipo IV de la clasificacion de McKee), que siendo tratada inicialmente con reduccion abierta y fijacion interna, requirio finalmente la implantacion de una hemiartroplastia de resuperficializacion del capitellum asociada a una reconstruccion del complejo del ligamento colateral externo. Este procedimiento quirurgico ha supuesto para el paciente una mejoria evidente del dolor y del balance articular del codo, manteniendo intacta la posibilidad de realizar otras tecnicas quirurgicas de rescate si fuera necesario mas adelante.

The early establishment of the diagnosis of a syndesmotic injury is essential for treatment selection. However, such injuries may not be apparent radiographically. Previous studies have attempted to describe correlations between medial malleolar fracture geometry and syndesmotic disruption. The main objective of this study was to create predictive models for assessing syndesmotic injuries based on an originally described angle, i.e., the medial crural–focal angle (MCFA). This study included 138 ankle fractures involving the medial malleolus. Any measure from the plain radiograph that could potentially lead to the suspicion of a syndesmotic disruption was recorded, and the newly described MCFA (formed by the main line of the medial malleolus fracture and a line perpendicular to the bearing surface of the tibial plafond) was also recorded. The inter- and intraobserver reliabilities were obtained using Krippendorff’s alpha coefficients. To examine the predictive abilities of every parameter, several statistical methods were applied including logistic regression, an ad hoc clinical rule, and discriminant analysis. After variable selection, we obtained the best possible logistic model. The variables that were found to be statistically significant were the MCFA, the tibiofibular clear space (TFCS) and the type of injury in the Lauge–Hansen (L–H) classification. This model was tested by cross validation, which revealed a mean percentage of correctly classified patients of 88%. A simpler and more intuitive alternative model was sought that was based solely on the influences of the MCFA and the TFCS. Our study revealed that an absence of syndesmotic disruptions when the MCFA was under 60°, and there were no uninjured patients with tibiofibular clear space values over 6 mm. Cross-validation revealed that the mean percentage of patients who were correctly classified with this model was 86%. The application of discriminant analysis to this combination of variables resulted in a function was able to correctly classify a mean of 84% of patients. In conclusion, three models that can predict syndesmotic injury using parameters from preoperative plain radiographs were obtained and validated. The MCFA measurement was in these models and found to be a reliable technique.

To assess the long-term results of trapeziometacarpal arthrodesis using a quadrangular plate, regarding clinical, radiological and functional outcomes, as well as development of complications. From 2005 to 2015, 70 patients were treated at our institution for primary osteoarthrosis of thumb carpometacarpal joint performing a trapeziometacarpal arthrodesis. A total of 85 arthrodesis were carried out using a titanium quadrangular plate (Proflyle plate, Stryker®, Kalamazoo MI, USA), without grafting in any case. Pre- and postoperative functional data were assessed at the outpatient clinics using DASH, MWS and VAS. All patients were asked for their ability to perform basic daily activities before and after surgery. All patients were also asked about satisfaction and their return to their jobs after surgery. Pre- and postoperative radiological data were also assessed. There were 59 females and 11 males with an average age of 55 years (range 44–60). In 66 cases arthrodesis was carried out in the dominant hand, in 45 cases the right thumb was involved, and in 40 the left thumb was involved; in 15 cases arthrodesis was carried out bilaterally. Preoperative average DASH score was 64 (range 50–85), postoperative average score was 25 (range 5–61). Regarding MWS, 51 patients obtained excellent results, 15 patients obtained good results and 4 patients referred poor results. The preoperative average score of VAS was 6 (range 5–10), which decrease to an average of 2 (range 0–3) after surgery; all those differences were statistically significant. All patients reported a mild loss of motion; however, all of them reported improvement to carry out daily activities. There were four cases of nonunion because of failure of fixation and two cases with dysesthetic scar. There was no development of osteoarthritis in adjacent joints. The average follow-up was 60 months. The use of quadrangular plates for arthrodesis of the trapeziometacarpal joint is a safety and reproducible technique with a low rate of complications. Arthrodesis decreases pain and improves function in patients with primary osteoarthritis of the thumb carpometacarpal joint; in spite of a mild loss of motion, patients are satisfied with this procedure.

Treatment of acute complex fracture-dislocation of the elbow has been associated with a high rate of complications. Internal Joint Stabilizer of the Elbow (IJSE) device appears as a valid option to optimize and improve our results.We present a retrospective case series of five patients treated at our institution with IJS-E System (Skeletal DynamicsR) from February 2019 to 2020. Our inclusion criteria was: patients over 18 years old surgically treated with IJS-E due to persistent elbow instability despite of a suitable osteoligamentous surgical repair.We obtained a total of five patients (4 males and 1 female) with an average age of 37.4 years old (24-71). The Injury pattern was posterolateral instability, TTIE in all cases. The mean final postoperative MEP score was 94 points (85-100) and the postoperative DASH score was 11.78 points (4.2-20.6) with an average follow-up of 9.8 months (6-12). We described a final arc of motion of 134° with a range of flexionbetween 120° and 140° and a mean lack of extension of 12° (5°-20°), with a complete arc of pronosupination. As complications we found one case of heterotopic ossfication and one case of elbow stiffnes. However, no complications device-related or articular incongruence were reported during follow-up.The IJS-E device appears as an effective alternative instead of external fixation. Nevertheless, a high rate of reoperation up to 100% is associated with IJS-E. A larger series, longer follow-up and prospective studies are needed to define properly his role in the surgical treatment of acute elbow instability.

Purpose The goal of this study was to describe the surgical technique and our results with arthroscopic posterior subtalar arthrodesis. Material and Methods Retrospective case series of 65 patients (38 men and 27 women) averaging 50 years of age (range 21–72 years) undergoing posterior arthroscopic subtalar arthrodesis using one or two percutaneous 6.5–7.3mm screws between May 2004 and February 2011, with a mean follow-up of 57.5 months (range 24–105 months). Results We achieved a 95.4% union rate after an average of 12.1 weeks (range 9 to 16 weeks). 12.3% of patients suffered complications, including superficial infection, nonunion and need for hardware removal. The AOFAS score improved from 51.5 points (19–61 points) preoperatively to 81.9 points (60–94 points) in the postoperative period. Conclusions We describe the surgical technique for arthroscopic subtalar arthrodesis, which as proven to be a safe and reliable technique in our experience, with consistent improvements in AOFAS scores.

Factors that impede closed reduction in intertrochanteric fractures remain unknown. This study was designed with the aim of establishing radiological variables that can predict an open reduction when nailing those type of fractures.Observational prospective study carried out between March 2013 and March 2015. Patients of both gender who suffered an intertrochanteric fracture, and who were surgically treated by intramedullary nailing (PFN-A), were included. Patients were evaluated by means of a questionnaire designed in 12 de Octubre Trauma department. Radiological parameters assessed preoperatively, after fracture reduction in the traction table, and after fixation were: calcar, lateral wall and posterior buttress integrity or disruption; lesser trochanter location, varus or valgus deformities, and flexion or extension of the proximal fragment.Association between open reduction and the following types of fractures was statistically significant (p0.001): subtypes A2.3, A3.2 and A3.3 of AO classification and subtypes IV and V of Evans classification. There were four radiological parameters associated with the need for open reduction: disruption of lateral wall (p0.0000), posterior wall fracture (p0.001), calcar (p0.004) and malalignment in the axial view (p0.001).Open reduction seems to be necessary for complex fracture patterns such as A2.3, A3.2 and A3.3 types of AO/OTA classification, as well as types IV and V of Evans classification. There are four major radiological parameters that can predict the need of approaching the fracture site: posterior buttress, calcar disruption, lateral wall disruption and proximal fragment flexion. The development of high quality evidence regarding this topic is necessary due to the vast impact that open reduction can have on elderly patients.

Background:The goal of this study was to compare results with arthroscopic posterior subtalar arthrodesis between patients treated for adult-acquired flatfoot deformity (AAFD) due to posterior tibial tendon dysfunction and patients with posttraumatic subtalar arthritis.Methods:Retrospective case series of 61 consecutive patients (group 1: posttraumatic arthritis, n = 37; group 2: AAFD, n = 24) averaging 49 years of age (range, 21-72 years) undergoing posterior arthroscopic subtalar arthrodesis via 1 or 2 percutaneous 6.5- to 7.3-mm screws, with a mean follow-up of 57.5 months (range, 24-105 months). Fusion was defined as the appearance of bony trabeculae across the subtalar joint on standard x-rays, along with clinical signs of union.Results:Patients with posttraumatic arthritis (group 1) were more predominantly male and younger than patients treated for AAFD (group 2). Overall, we achieved a 95.1% radiologic union rate after an average of 11.7 weeks. Complications appeared in 14.8% of patients. Union rate and complications did not differ significantly between groups. American Orthopaedic Foot & Ankle Society (AOFAS) scores improved significantly for both patient groups, although patients with AAFD showed significantly larger improvement and higher postoperative AOFAS scores, even after adjusting for age and sex (mean improvement in AOFAS scores: 27.0 ± 9.1 points for the posttraumatic arthritis group vs 34.9 ± 7.4 points for the AAFD group; P < .001).Conclusions:Arthroscopic subtalar arthrodesis was a safe and reliable technique, with consistent improvement in AOFAS scores throughout different patient subgroups, as well as comparable time to union and complication rates. Improvements were larger for patients treated for AAFD, even after adjusting for age and sex.Level of Evidence:Level III, retrospective case series.

La técnica de Sauvé-Kapandji se emplea como tratamiento de rescate en la patología de la articulación radiocubital distal (ARCD). Los resultados postoperatorios son buenos, aunque a largo plazo pueden surgir complicaciones como dolor, muñón cubital inestable y pérdida de fuerza de prensión. Presentamos un caso de cirugía de rescate de esta técnica mediante prótesis de cúbito distal. A los cuatro años de seguimiento, el paciente presenta desaparición completa del dolor y recuperación de la fuerza de prensión, lo que hace pensar que la prótesis cubital puede ser un buen método de rescate cuando fracasa un Sauvé-Kapandji.

Resumen Introduccion La patologia de los tendones peroneos es una causa frecuente de dolor posterolateral de tobillo. En los ultimos anos, la incidencia y el conocimiento de esta patologia y de su tratamiento estan en auge gracias al desarrollo de las tecnicas tendoscopicas. Objetivo Describir y evaluar el estado actual y las indicaciones de la tendoscopia en la patologia de los tendones peroneos. Material y metodo Desde junio de 2010 hasta julio de 2011 se realizaron 23 tendoscopias en pacientes con dolor retrofibular persistente. Encontramos 12 casos de rotura del peroneus brevis, 6 del peroneus longus, 3 casos de tenosinovitis y 2 casos de luxacion, uno de ellos con una luxacion intravaina y otra extravaina. De los 23 pacientes, 12 presentaban ademas otra lesion asociada: 4 lesiones osteocondrales de astragalo, 3 inestabilidades anterolaterales de tobillo y 7 casos de pinzamiento de partes blandas. Discusion Las 3 indicaciones principales de esta tecnica son las tenosinovitis, las roturas tendinosas y la luxacion de los tendones. Es un procedimiento tecnicamente exigente, que requiere una amplia experiencia en el tratamiento artroscopico de pequenas articulaciones y puede ser especialmente complejo en los casos de tenosinovitis extensa o amplias roturas tendinosas, pero muy util para la evaluacion y tratamiento de dicha patologia. Conclusiones La tendoscopia es un procedimiento de gran utilidad en el abordaje de la patologia de los tendones peroneos, con baja morbilidad y excelentes resultados funcionales.

Background The peroneal tendon pathology is a common cause of posterolateral ankle pain. Recently, the incidence and awareness of this disease and its treatment are booming thanks to the development of tendoscopic procedures. Objective To describe and assess the current role and indications of tendoscopy for peroneal tendon pathology. Material and methods From June 2010 to July 2011, twenty three patients with retrofibular pain were treated with peroneal tendoscopy. We founded twelve peroneal brevis tendon tears, six peroneal longus tendon tears, three cases of tenosynovitis and two cases of luxation, one patient with an intrasheath subluxation and another one of extrasheath. Of the 23 patients, 12 had another injury associated: 4 talar osteochondral lesions, 3 instabilities and 7 cases of soft tissue impingement. Discussion The three main indications include tendon tears, tenosynovitis and subluxation or luxation. It is a technically demanding procedure that requires extensive experience in arthroscopic management of small joints and can be particularly complex in cases of wide tenosynovitis, broad tendon tears or anatomical defects but very useful for the evaluation of the lesions and for the treatment of peroneal tendon disorders. Conclusions Tendoscopy is a useful procedure with low morbidity and excellent functional results to treat the pathology of the peroneal tendons.

The aim of the present study is to analyse complications after a floating elbow injury, attempting to establish which of them act as a poor prognosis factor regarding clinical and functional results. Twenty-three patients who suffered a floating elbow injury, treated at our institution from 2004 to 2013, were retrospectively reviewed. Patients were divided into four groups depending on the type of injury. An analysis of demographic data, associated injuries, treatment options and complications was carried out. Clinical evaluation was made by a conventional goniometer, testing flexo-extension and prono-supination ranges. For functional evaluation, the Mayo Elbow Performance Score was employed. Association between radioulnar synostosis, articular surface disruption, nerve injury and clinical and functional results was analysed. Patients with radioulnar synostosis had worse results in functional evaluation than patients without it (56.6 vs. 75); this difference was statistically significant (p = 0.05). Regarding intra-articular extension, we found statistical association with worse results in functional evaluation (p = 0.018); however, nerve palsy does not seem to influence functional results. Radioulnar synostosis and intra-articular extension of the injury are poor prognosis factor in floating elbow.

Introduction The distal triceps tendon rupture is an uncommon injury. The acute treatment is well-defined, but when a delayed diagnosis is made or when a tendon retraction is present the alternatives or reconstruction are limited and sometimes complex. Case Presentation In this case, we report on a 28-year-old man who presented with a chronic disruption of the distal triceps tendon with a gap of approximately 15 cm. The patient was diagnosed in another center with an inveterate breakage of the distal triceps tendon and was initially treated with an Achilles allograft that was complicated by a wound infection and required more than ten surgeries. Nearly 22 months after the initial trauma, and 12 months after the first surgery, we performed a reconstruction with an Achilles tendon allograft using the new technique of distal attachment. At the 12-month follow-up the patient presented a joint balance from -5º to 110º and presented with no pain. Conclusions The use of an Achilles tendon allograft provides excellent results in complex distal triceps tendon ruptures. We report the use of a new technique to anchor a distal Achilles allograft.