Inestabilidad Del Carpo Final

Inestabilidad del Carpo Dra. Rayén Aránguiz Borgeaud CAS/UDD –HCMDS

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Introducción Inestabilidad Inest abilidad clínica del carpo: •

Muñeca con una disfunción sintomática, no capaz de tolerar cargas cargas fisiológicas y no exhibe una cinemática normal en todo su arco de movimiento . *

Historia •

Destot 1926 describe mal alineamiento del carpo posterior a la lesión l esión de sus ligamen li gamentos. tos.

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EPIDEMIOLOGÍA •

•

•

5% de las muñecas traumáticas sin lesión ósea tienen lesión escafolunar. (Jones 1988) En fracturas de EDR 30% tiene lesiones ligamentosas asociadas. (Tang 1992) Pacientes con AR presentan

un 40% de

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Anatomía •

Ligamentos Intrínsecos Origen e inserción en huesos del carpo Importantes Escafolunar (dorsal) Lunotriquetal (palmar)  –

 –

•

•

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Anatomía •

Ligamentos extrínsecos palmares Radiescafocapitate Radiolunar largo Radiolunar corto Ulnolunate Ulnotriquetal  –

 –

 –

 –

 –

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Anatomía •

Ligamentos extrínsecos dorsales Radiocarpiano dorsal Intercarpiano  –

 –

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Generalidades biomecánica Concepto Anillo de Lichtman •

Fila distal carpo, unidad fija,

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Mecánica lesiones ligamentosas del carpo Mecanismos directos •

Mano atrapada en prensa de fuerza o máquina de rodillos

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Inestabilidad perilunar progresiva Estadio I Disociación escafolunar o fractura escafoides

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Inestabilidad perilunar progresiva Estadio II Luxación semilunar- hueso grande Complejo escafoides-fila distal se luxa •

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Inestabilidad perilunar progresiva Estadio III Disrupción lunopiramid l unopiramidalal-

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Diagnóstico e Imágenes

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Tratamiento

Estadios Est adios del I al V

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Disociación Escafolunar •

Estadio I Inestabilidad predinámica Agudo: Fijación con agujas K Crónico: Fijación con Agujas K mas capsulodesis •

 –

•

 –

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Disociación Escafolunar •

Estadio II Disociación dinámica  –

Aguda: Lig. repar reparable able Reparación Repar ación directa Lig EL con ancla Fijación agujas EL y EC Inmovilización 8 sem •

•

•

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Estadio III (Crónica /Dinámica/Lig. Dorsal no reparable) •

•

Capsulodesis dorsal + reparación del ligamento EL (BLA (BLATT TT seguimi seguimiento ento 4.5 a) Técnica + fácil fáci l Inmovilización Inmovilizació n 8 sem Reducción parcial del dolor No mantiene alineación a largo plazo.  –

 –

 –

 –

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Disociación Escafolunar •

Estadio IV (Disociación estática reductible/ Sin daño de cartílago).  –

Reconstrucciones tendinosas Marc Garcia Elias Triple ligamento •

 –

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Disociación Escafolunar •

Estadio V: Disociación est e stática ática no reductible/ Cartílago sano

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Disociación Escaf Escafolunar olunar Estadio VI Disociación estática no reductible mas artrosis SLAC •

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Lesión Aislada Ligamen Ligamento to

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Lesión Lunotriquetal Teoría eoríass de la mecánica patológica •

Inestabilidad progresiva progresiva perilunar (Estadío III de Mayfield).

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Lesión Lunotriquetal Mecánica Patológica Rotación en flexión escaf escafoides oides

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Tratamiento quirúrgico •

•

Abordaje: Volar Ventajas: Mejor exposición Fácil reducción, acceso a las fracturas distales de escafoide Capacidad de reparar lig. Volares. Permite descomprimir túnel carpiano  –

• •

• •

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•

Dorsal  –

Desventajas •

 –

Menos facilidad para reducción

Ventajas: •

Permite buena exposición a fila proximal y a la mediocarpiana Menos daño partes blandas

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Tratamiento quirúrgico •

Lesiones de arco mayor: Estabilización Estabilizaci ón osea: Escafoides: Tornillo compresivo Estiloides: Agujas K , tornillos canulados, placa placa fragmento específico. Lesiones de arco menor: Reparación lig. Escafolunar crítico Reparación de lig. Lunotriquetal no esta avalado por la literatura.  –

•

•

•

 –

 –

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Inestabilidad Inest abilidad carpiana compleja

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Inestabilidad Inest abilidad carpiana compleja Fracturas axiales del Carpo •

•

•

Afección concavidad palmar del carpo Traumatismo dorso palmar alta energía Aplastamiento.

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Inestabilidad Inest abilidad carpiana compleja •

Muñeca dividida en 2 columnas

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Inestabilidad Inest abilidad carpiana compleja Luxación aislada huesos del carpo •

Raro pero todos los huesos

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Inestabilidad Inest abilidad carpiana no

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Inestabilidad carpiana no disociativa Clasificación

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Inestabilidad Inest abilidad carpiana no disociativ disociativaa radiocarpiana Desplazamiento Desplazamient o Ulnar •

Rotura o insuficiencia ligamentos oblicuos radiocarpianos.

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Desplazamiento Ulnar Clasificación de Telesnik

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Tratamiento

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Inestabilidad carpiana no disociativa radiocarpiana

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