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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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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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 •
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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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