Case report
Treatment of proximal radioulnar synostosis using a posterior interosseous antegrade flow pedicled flap
Tratamiento de la sinostosis mediante colgajo interóso posterior
F. Martínez-Martíneza,
, J.M. Moreno-Fernándeza, A. García-Lópezc, V. Izquierdo-Santiagob, S. Illan-Francoa
Corresponding author
a Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
b Servicio de Cirugía Plástica y Reparadora, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
c Servicio de Traumatología y Cirugía Ortopédica, Hospital General Universitario de Alicante, Alicante, Spain
Read
4864
Timeswas read the article
598
Total PDF
4266
Total HTML
Share statistics
array:24 [ "pii" => "S1988885614000224" "issn" => "19888856" "doi" => "10.1016/j.recote.2014.02.002" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "431" "copyright" => "SECOT" "copyrightAnyo" => "2013" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Rev Esp Cir Ortop Traumatol. 2014;58:120-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1052 "formatos" => array:2 [ "HTML" => 895 "PDF" => 157 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441513001288" "issn" => "18884415" "doi" => "10.1016/j.recot.2013.07.009" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "431" "copyright" => "SECOT" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Rev Esp Cir Ortop Traumatol. 2014;58:120-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3184 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 2763 "PDF" => 409 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nota clínica</span>" "titulo" => "Tratamiento de la sinostosis radiocubital proximal mediante la interposición de colgajo interóseo posterior de flujo anterógrado" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "120" "paginaFinal" => "124" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment of proximal radioulnar synostosis using a posterior interosseous antegrade flow pedicled flap" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 1033 "Tamanyo" => 85634 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En las imágenes (a) y (b) se muestran las radiografías anteroposterior y lateral, y en la (c) la TAC donde se aprecia la sinostosis generada tras la implantación de arpones para la reinserción del tendón del bíceps. En la línea inferior se muestra la radiografía postoperatoria (d), y al año (e) con ausencia de la sinostosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Martínez-Martínez, J.M. Moreno-Fernández, A. García-López, V. Izquierdo-Santiago, S. Illan-Franco" "autores" => array:5 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Martínez-Martínez" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Moreno-Fernández" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "García-López" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Izquierdo-Santiago" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Illan-Franco" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885614000224" "doi" => "10.1016/j.recote.2014.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885614000224?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513001288?idApp=UINPBA00004N" "url" => "/18884415/0000005800000002/v1_201403250026/S1888441513001288/v1_201403250026/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885614000212" "issn" => "19888856" "doi" => "10.1016/j.recote.2014.02.001" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "420" "copyright" => "SECOT" "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "crp" "cita" => "Rev Esp Cir Ortop Traumatol. 2014;58:125-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 660 "formatos" => array:2 [ "HTML" => 461 "PDF" => 199 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Paravertebral and intra-abdominal abscess due to oxygen-ozone therapy for lower back pain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "125" "paginaFinal" => "127" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Absceso paravertebral e intraabdominal secundario a ozonoterapia por lumbalgia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 489 "Ancho" => 1302 "Tamanyo" => 89873 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) CT scan showing the paravertebral abscesses (arrows). (B) CT scan showing the abscess at the level of the left iliopsoas muscle.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Menéndez, A. García, R. Peláez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Menéndez" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "García" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Peláez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441513000970" "doi" => "10.1016/j.recot.2013.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513000970?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885614000212?idApp=UINPBA00004N" "url" => "/19888856/0000005800000002/v1_201403190006/S1988885614000212/v1_201403190006/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885614000108" "issn" => "19888856" "doi" => "10.1016/j.recote.2014.01.009" "estado" => "S300" "fechaPublicacion" => "2014-03-01" "aid" => "460" "copyright" => "SECOT" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2014;58:114-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 523 "formatos" => array:2 [ "HTML" => 385 "PDF" => 138 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Osteogenesis imperfecta: Treatment and results of a case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "114" "paginaFinal" => "119" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteogénesis imperfecta: tratamiento y resultado de una serie de casos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 865 "Ancho" => 1001 "Tamanyo" => 68878 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Seven-and-a-half-year-old patient operated on with a telescopic endomedullary nail for correction of a deformity in the femur (A). At age 15, the nail has hardly migrated at all and the shaft has been lengthened to adapt to bone growth (B). The patient did not require reintervention at any time during follow-up.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R.J. Escribano Rey, J. Duart-Clemente, O. Martínez de la Llana, J.L. Beguiristáin Gúrpide" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R.J." "apellidos" => "Escribano Rey" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Duart-Clemente" ] 2 => array:2 [ "nombre" => "O." "apellidos" => "Martínez de la Llana" ] 3 => array:2 [ "nombre" => "J.L." "apellidos" => "Beguiristáin Gúrpide" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441513001963" "doi" => "10.1016/j.recot.2013.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441513001963?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885614000108?idApp=UINPBA00004N" "url" => "/19888856/0000005800000002/v1_201403190006/S1988885614000108/v1_201403190006/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Treatment of proximal radioulnar synostosis using a posterior interosseous antegrade flow pedicled flap" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "120" "paginaFinal" => "124" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Martínez-Martínez, J.M. Moreno-Fernández, A. García-López, V. Izquierdo-Santiago, S. Illan-Franco" "autores" => array:5 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Martínez-Martínez" "email" => array:1 [ 0 => "fmtnez@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J.M." "apellidos" => "Moreno-Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "García-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "V." "apellidos" => "Izquierdo-Santiago" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "S." "apellidos" => "Illan-Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Plástica y Reparadora, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Traumatología y Cirugía Ortopédica, Hospital General Universitario de Alicante, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la sinostosis mediante colgajo interóso posterior" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 943 "Ancho" => 1334 "Tamanyo" => 227077 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The image (a) shows the synostosis (fragments of the synostosis are in smaller size), and (b) the flap with the posterior interosseous artery and perforating septal. The image (b) also shows the everted flap to be interposed in the area of synostosis, and the (d) anterior cutaneous anchor which stabilizes the flap.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Radioulnar synostosis is a heterotopic ossification of the interosseous membrane of the forearm which blocks rotational movements, representing a significant limitation for basic everyday activities.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its origin can be congenital or posttraumatic.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The most common form is the congenital, with posttraumatic occurrence being relatively uncommon. The true incidence of posttraumatic radioulnar synostosis is unknown, but it is estimated to appear in 1.2<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>–6.6%<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> of patients with fractures of one or both forearm bones treated with compression plates. In addition, there are other risk factors arising from the type of local lesion (open fracture, comminution and associated dislocations), surgical technique (approaches,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> immobilization or repair of the distal biceps insertion in up to 7%<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a>) and other distant lesions and the condition of patients (traumatic brain injury [TBI], in up to 18% of cases<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>).</p><p id="par0015" class="elsevierStylePara elsevierViewall">This lesion can be located along the various thirds of the forearm. Its length in the proximal third can vary and affect the elbow joint.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Multiple treatment alternatives have been proposed, with the surgical option being the first choice. Isolated resection of the calcifications has a high rate of recurrence, so various techniques for interposition of artificial or biological material to act as a barrier between both bone surfaces have been developed. Traditionally, materials such as silicone,<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8–10</span></a> bone wax<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and soft parts like free fat<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11–13</span></a> have been used. However, these techniques were not able to prevent recurrence and non-vascularized<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> tissue could be replaced by necrotic tissue. Subsequently, especially in the cases of congenital synostosis, interposition techniques using vascularized tissue from the anconeus,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleItalic">brachioradialis</span> and <span class="elsevierStyleItalic">flexor carpi ulnaris</span> muscles,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> vascularized, pedicled or free flaps<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> were employed using the radial or posterior interosseous artery.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19–23</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The use of posterior interosseous adipofascial flaps in radioulnar synostosis with a posttraumatic origin has been sparsely described prior to article.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19,22,23</span></a> This highly useful flap was originally described by Zancolli and Angrigiani in 1988,<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and Penteado et al. in 1986.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Multiple adjuvant treatments with NSAIDs have been proposed in conservative treatments, such as indometacin, perioperative irradiation at low doses<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26,27</span></a> and postoperative rehabilitation which may prevent recurrence.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We present 2 cases in which we used the adipofascial posterior interosseous flap with antegrade flow to interpose it as biological material at the focus of synostosis following its excision in order to prevent recurrence of the lesion.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case reports</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Case 1</span><p id="par0040" class="elsevierStylePara elsevierViewall">A 45-year-old male who suffered a posttraumatic rupture of the <span class="elsevierStyleItalic">biceps brachii</span> insertion tendon at the level of the radial tuberosity in his left arm while carrying out his work activities, without any other associated injuries. Tendon reinsertion was performed using 2 metal harpoons and posterior rigid immobilization was established for 4 weeks.</p><p id="par0045" class="elsevierStylePara elsevierViewall">During the rehabilitation process, the patient presented a blockage of forearm pronosupination at 75° pronation. Plain radiographs (anteroposterior and lateral) and a computed tomography (CT) scan of the affected elbow were obtained, showing a bone bridge in the proximal third of the radius and ulna at the level of the radial tuberosity (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient was diagnosed with radioulnar synostosis, type III in the Vince classification<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> or proximal type IIIA in the Jupiter classification.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The patient was scheduled for surgery (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which was carried out through a posterior forearm approach which enabled excision of the heterotopic calcifications. Recovery of the passive rotational movement of the forearm, with full articular balance, was verified immediately.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Subsequently, we performed an interosseous posterior fascio-fatty flap with antegrade flow through distal extension of the posterior approach, and an 8-10<span class="elsevierStyleHsp" style=""></span>cm dissection of the subcutaneous fascio-fatty plane between the <span class="elsevierStyleItalic">extensor carpi ulnaris</span> and <span class="elsevierStyleItalic">extensor digiti minimi</span> including the septum between both where the posterior interosseous artery, along with its vein, was located. A 6-8<span class="elsevierStyleHsp" style=""></span>cm wide adipofascial pedicled flap with antegrade flow was obtained. Next, it was turned 180° so that the distal third of the flap could be interposed at the site of calcification between both bones, in order to prevent recurrence of the lesion. A small anterior incision was made to recover the flap and attach it to the skin through suture and a dermal button, so it prevented mobilization and retraction of the interposed tissue and allowed patient rehabilitation to start as early as possible. The approximate duration of the surgical intervention was 120<span class="elsevierStyleHsp" style=""></span>min.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Postoperative immobilization of the elbow was maintained for 1 week and mobilization of the joint was started immediately thereafter.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The patient presented satisfactory functional results during monitoring in consultation. At 3 months, the patient was able to perform 75° pronation (contralateral value of 75°) and 75° supination (contralateral value of 85°) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) which were maintained until discharge. The radiological control conducted in the immediate postoperative period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and 1 year later showed no recurrence of the synostosis bone bridge.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">No complications, such as infection, hematoma and distal neurovascular involvement, were observed. The range of motion was maintained until discharge 1 year after surgery. The patient was satisfied with the results and was able to return to his previous employment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Case 2</span><p id="par0075" class="elsevierStylePara elsevierViewall">A 23-year-old male, who suffered TBI due to a motorcycle accident, requiring ICU admission and mechanical ventilation for 19 days. At 5 weeks after the accident he attended consultation due to deformity and functional limitation of the left forearm, with a blockage in 50° pronation. We obtained simple radiographs (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) which showed malunion in shortening-rotation of the ulna with hypertrophic callus and proximal type IIIA radioulnar synostosis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">The patient underwent focal osteotomy, excision of the hypertrophic callus plus the synostosis, osteosynthesis with a plate and posterior interosseous fascio-fatty flap, as described for the first case.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The patient presented satisfactory functional results during the follow-up visit. At 3 months, he reached 70° pronation (contralateral value of 75°) and 80° supination (contralateral value of 85°). Postoperative radiographs and a CT scan (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) showed a fracture callus with no presence of synostosis.</p><p id="par0090" class="elsevierStylePara elsevierViewall">No complications, such as infection, hematoma and distal neurovascular involvement, were observed. The range of motion was maintained until discharge, 1 year after surgery. The patient was satisfied with the results and returned to his previous employment.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">Radioulnar synostosis is rare in its congenital form, but even rarer as a posttraumatic complication. It produces major joint limitation for patients, making it a very disabling injury.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The recurrence rate after simple excision is high. Based on 3 extensive cases series, after excision of a primary synostosis this rate was 32%.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,29</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">In 2002, Kamineni et al.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> suggested proximal resection of the radius for cases with severe posttraumatic proximal radioulnar synostosis where it was not possible to excise the synostosis, with a mean rotational range of 98° during follow-up. Thus, it was considered that flaps or interposition techniques may not be necessary.</p><p id="par0110" class="elsevierStylePara elsevierViewall">After using some artificial materials, like silicone, or non-vascularized biological materials, such as fat and fascia, the interposition of vascularized grafts was reported. In 1999, Bell and Benger<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> reported 3 patients with type III radioulnar synostosis who were successfully treated through a vascularized graft of anconeus muscle interposed after excision which improved forearm rotational range up to 130°. In 2004, Fernandez and Joneschild<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> used a <span class="elsevierStyleItalic">brachioradialis</span> flap in 3 cases and a <span class="elsevierStyleItalic">flexor carpi ulnaris</span> flap in 2 cases, with excellent results.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In 1998, Kanaya and Ibaraki<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> described a vascularized adipofascial free graft from the side of the arm dependent on the posterior radial collateral artery in 7 children with congenital proximal radioulnar synostosis, with rotation ranges of 71° upon monitoring. In 2004, Muramatsu et al.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> reported 2 patients with posttraumatic radioulnar synostosis treated by interposition of a vascularized inguinal free graft, with ranges of 130° in both cases. Although the results of the interposition of vascularized free grafts were promising, they did require expertise in microsurgery and could cause morbidity in the donor region.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The interposition of vascularized pedicled grafts, such as radial or posterior interosseous flaps, seems to be a good alternative to the previously described techniques. These flaps are safe and relatively simple to obtain, without requiring microsurgical anastomosis. Few cases of radioulnar synostosis treated through vascularized pedicles flaps have been described to date, especially in children.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In 1996, Sugimoto et al.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> presented a case of posttraumatic type III radioulnar synostosis treated by resection and interposition of a posterior interosseous flap. However, 1 year later the patient presented a rotational range of only 65°. In 2004, Funakoshi et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> described a patient with congenital bilateral radioulnar synostosis treated with a pedicled posterior interosseous fat graft, obtaining a rotational balance of 60° pronation and 10° supination for both forearms. In 2004, Jones et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> presented a patient with posttraumatic type II synostosis, successfully treated by resection and interposition of a radial adipofascial flap. In 2007, Jones et al.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> reported excellent results in 4 children treated with posterior interosseous proximal base adipofascial flaps. Recently, in 2011, Sonderegger et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> described 6 patients with posttraumatic radioulnar synostosis, 5 type III and 1 type I, treated by resection and interposition of a pedicled adipofascial flap, 4 of the radial artery and 2 of the posterior interosseous, with excellent results and a mean rotational range of approximately 140°.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The use of the radial artery for these types of flaps may affect the distal vasculature, resulting in donor site morbidity. Moreover, it poses anatomical difficulties that limit its use in cases of proximal radioulnar synostosis.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Pedicled adipofascial flaps of the proximal base with posterior interosseous or antegrade flow can be obtained without great difficulties, following the directions proposed by Penteado et al. in 1986<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> and Zancolli and Angrigiani in 1988.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> The distal apex allows them to be turned on themselves to be moved proximally to their pedicle and used in the proximal third of the forearm. We recognize that obtaining this flap requires an extensive surgical approach in the dorsal aspect of the forearm, compared to that required for a simple excision of the synostosis, although none of our patients expressed their concern about this issue.</p><p id="par0140" class="elsevierStylePara elsevierViewall">We believe that the attachment of the flap to the affected area is a very important part of this technique. Most authors leave the vertex of the flap interposed in the affected region without any anchor. Others prefer to use suture anchors to prevent flap retraction. In our case, the system of percutaneous anchor with a button guarantees the interposition without any risk of retraction and without adding new fixation material in the affected region, which we believe could enhance the onset of new heterotopic ossification in the area.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Excision of the lesion along with the interposition of a posterior interosseous flap with antegrade flow and anterior percutaneous anchor is a valid technique for the treatment of posttraumatic radioulnar synostosis located in the proximal third of the forearm, with excellent functional results and a low rate of recurrence.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Level of evidence</span><p id="par0150" class="elsevierStylePara elsevierViewall">Level of evidence iv.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Protection of people and animals</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Confidentiality of data</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of patient data and that all patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Right to privacy and informed consent</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare having obtained written informed consent from patients and/or subjects referred to in the work. This document is held by the corresponding author.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres322603" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec304961" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres322604" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec304960" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Case reports" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 2" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 8 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec304961" "palabras" => array:3 [ 0 => "Synostosis" 1 => "Radioulnar" 2 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec304960" "palabras" => array:3 [ 0 => "Sinostosis" 1 => "Radiocubital" 2 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to determine the different therapeutic options described for the treatment of radioulnar synostosis, and report our experience with posterior interosseous antegrade flow pedicled flap with technical amendments. Two patients, who were treated with the designed flap, and with more than one year of follow-up, were reviewed. The technical innovations, end result and complications are described. In the two cases described, there was no recurrence of synostosis, which is the most frequent complication described in this condition, and no postoperative complications were observed. In the literature, many filler materials, from artificial to biological, free or vascularized, have been used the radioulnar space after excision of synostosis. The technique that provides the best results is the interposition of muscle or vascularized adipofascial flaps. The interosseous posterior antegrade flow pedicled flap is reliable, with a low morbidity, and is an effective alternative for the treatment of proximal radioulnar synostosis.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Nuestro objetivo es estudiar las diferentes opciones terapéuticas descritas para el tratamiento de la sinostosis radiocubital y, aportar nuestra experiencia con las modificaciones técnicas introducidas con posterioridad. Hemos revisado 2 pacientes con más de un año de evolución, que fueron operados con el colgajo reseñado; describimos las novedades técnicas, el resultado final y las complicaciones. En los 2 casos descritos existe ausencia de recidiva de sinostosis, complicación más frecuente descrita en esta enfermedad, con ausencia de complicaciones postoperatorias. En la literatura se han empleado numerosos materiales interpuestos en el espacio radiocubital tras la exéresis de la sinostosis, desde artificiales hasta biológicos libres o vascularizados; siendo la técnica de interposición de colgajos musculares o adipofascial vascularizados, la que ofrece los mejores resultados. El colgajo interóseo posterior pediculado de flujo anterógrado es una alternativa fiable, de poca morbilidad y, efectiva para el tratamiento de la sinostosis radiocubital proximal.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martínez-Martínez F, Moreno-Fernández JM, García-López A, Izquierdo-Santiago V, Illan-Franco S. Tratamiento de la sinostosis mediante colgajo interóso posterior. Rev Esp Cir Ortop Traumatol. 2014;58:120–124.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 943 "Ancho" => 1334 "Tamanyo" => 121831 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Images (a) and (b) show anteroposterior and lateral radiographs, whilst (c) is the CT scan showing the synostosis generated after the implantation of harpoons for the reinsertion of the biceps tendon. The inferior line shows the radiographs in the postoperative period (d) and at 1 year (e) with absence of synostosis.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 943 "Ancho" => 1334 "Tamanyo" => 227077 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The image (a) shows the synostosis (fragments of the synostosis are in smaller size), and (b) the flap with the posterior interosseous artery and perforating septal. The image (b) also shows the everted flap to be interposed in the area of synostosis, and the (d) anterior cutaneous anchor which stabilizes the flap.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 943 "Ancho" => 1334 "Tamanyo" => 166257 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Images (a) and (b) show an elbow extension of −5° and flexion of 125°. Images (c) and (d) show supination of −10° and full pronation.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 946 "Ancho" => 1334 "Tamanyo" => 96906 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Image (a) shows the synostosis secondary to ulnar malunion and (b) shows the postoperative CT revealing the bone separation in the area of synostosis. Image (c) shows the postoperative radiograph with correct consolidation without recurrence of synostosis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of posttraumatic radioulnar synostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.G. Bergeron" 1 => "N.M. Desy" 2 => "M. Bernstein" 3 => "E.J. Harvey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5435/JAAOS-20-07-450" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2012" "volumen" => "20" "paginaInicial" => "450" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22751164" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Compression-plate fixation in acute diaphyseal fractures of the radius and ulna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L.D. Anderson" 1 => "D. Sisk" 2 => "R.E. Tooms" 3 => "W.I. Park 3rd" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1975" "volumen" => "57" "paginaInicial" => "287" "paginaFinal" => "297" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1091653" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-traumatic radioulnarsynostosis after forearm fracture osteosynthesis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Bauer" 1 => "M. Arand" 2 => "W. Mutschler" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Orthop Trauma Surg" "fecha" => "1991" "volumen" => "110" "paginaInicial" => "142" "paginaFinal" => "145" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2059537" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Single versus double-incision technique for the repair of acute distal biceps tendon ruptures: a randomized clinical trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Grewal" 1 => "G.S. Athwal" 2 => "J.C. MacDermid" 3 => "K.J. Faber" 4 => "D.S. Drosdowech" 5 => "R. El-Hawary" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.K.00436" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "1166" "paginaFinal" => "1174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22760383" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications associated with repair of a distal biceps rupture using the modified two-incision technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Bisson" 1 => "M. Moyer" 2 => "K. Lanighan" 3 => "J. Marzo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Shoulder Elbow Surg" "fecha" => "2008" "volumen" => "17" "numero" => "Suppl. 1" "paginaInicial" => "S67" "paginaFinal" => "S71" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ruptures of the brachial biceps distal tendon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P.J. Delgado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Trauma Fund MAPFRE" "fecha" => "2008" "volumen" => "19" "paginaInicial" => "242" "paginaFinal" => "250" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Forearm fractures in the head-injured adult" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.E. Garland" 1 => "V. Dowling" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "1983" "paginaInicial" => "190" "paginaFinal" => "196" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6603941" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of silastic sheet in hand surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Carstam" 1 => "O. Eiken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Scand J Plast Reconstr Surg" "fecha" => "1971" "volumen" => "5" "paginaInicial" => "57" "paginaFinal" => "61" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5559734" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Silconized Dacron interposition for traumatic radio-ulnar synostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.F. Schneider" 1 => "S. Leyva" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Med Assoc State Ala" "fecha" => "1964" "volumen" => "33" "paginaInicial" => "185" "paginaFinal" => "188" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14110347" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevention of recurrent radioulnar heterotopic ossification by combined indomethacin and a dermal/silicone sheet implant: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "I.F. Lytle" 1 => "K.C. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsa.2008.09.008" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2009" "volumen" => "34" "paginaInicial" => "49" "paginaFinal" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19121730" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative treatment of post-traumatic proximal radioulnarsynostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.B. Jupiter" 1 => "D. Ring" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1998" "volumen" => "80" "paginaInicial" => "248" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9486731" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Traumatic radio-ulnar synostosis treated by excision and a free fat transplant. A report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K. Yong-Hing" 1 => "S.P. Tchang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "1983" "volumen" => "65" "paginaInicial" => "433" "paginaFinal" => "435" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6874714" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Free adipofascial flap interposition of pediatric posttraumatic forearm synostosis with closed head injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Henry" 1 => "F. Levaro" 2 => "D. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Ann Plast Surg" "fecha" => "2004" "volumen" => "53" "paginaInicial" => "506" "paginaFinal" => "509" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15502471" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of tensor fascia lata interposition grafts for the treatment of posttraumatic radioulnar synostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.B. Friedrich" 1 => "D.P. Hanel" 2 => "H. Chilcote" 3 => "L.I. Katolik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsa.2006.02.005" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2006" "volumen" => "31" "paginaInicial" => "785" "paginaFinal" => "793" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16713843" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of radioulnar synostosis with mobilization, anconeus interposition, and a forearm rotation assist splint" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.N. Bell" 1 => "D. Benger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Shoulder Elbow Surg" "fecha" => "1999" "volumen" => "8" "paginaInicial" => "621" "paginaFinal" => "624" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10633900" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wrap around pedicled muscle flaps for the treatment of recurrent forearm synostosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.L. Fernández" 1 => "E. Joneschild" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.bth.0000129887.23946.4e" "Revista" => array:6 [ "tituloSerie" => "Tech Hand Up Extrem Surg" "fecha" => "2004" "volumen" => "8" "paginaInicial" => "102" "paginaFinal" => "109" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16518121" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mobilization of a congenital proximal radioulnarsynostosis with use of a free vascularized fascio-fat graft" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Kanaya" 1 => "K. Ibaraki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg" "fecha" => "1998" "volumen" => "80A" "paginaInicial" => "1186" "paginaFinal" => "1192" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posttraumatic radioulnarsynostosis treated with a free vascularized fat transplant and dynamic splint: a report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K. Muramatsu" 1 => "K. Ihara" 2 => "M. Shigetomi" 3 => "K. Kimura" 4 => "Y. Kurokawa" 5 => "S. Kawai" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "48" "paginaFinal" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14676558" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of traumaticradioulnarsynostosis by excision, with interposition of a posterior interosseous island forearm flap" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Sugimoto" 1 => "K. Masada" 2 => "H. Ohno" 3 => "T. Hosoya" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Br" "fecha" => "1996" "volumen" => "21" "paginaInicial" => "393" "paginaFinal" => "395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8771487" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of pedicled posterior interosseous fat graft for mobilization of congenital radioulnarsynostosis: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. Funakoshi" 1 => "H. Kato" 2 => "A. Minami" 3 => "N. Suenaga" 4 => "N. Iwasaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1058274603002520" "Revista" => array:6 [ "tituloSerie" => "J Shoulder Elbow Surg" "fecha" => "2004" "volumen" => "13" "paginaInicial" => "230" "paginaFinal" => "234" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14997106" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of radio-ulnar synostosis by radical excision and interposition of a radial forearm adipofascial flap" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.F. Jones" 1 => "A. Esmail" 2 => "E.K. Shin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsa.2004.07.017" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2004" "volumen" => "29" "paginaInicial" => "1143" "paginaFinal" => "1147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15576229" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The use of a proximally based posterior interosseous adipofascial flapto prevent recurrence of synostosis of the elbow joint and forearm" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.E. Jones" 1 => "M.A. Rider" 2 => "J. Hughes" 3 => "M.A. Tonkin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsb.2006.09.004" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Eur Vol" "fecha" => "2007" "volumen" => "32" "paginaInicial" => "143" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17134798" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Preventing recurrence of radioulnar synostosis with pedicled adipofascial flaps" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Sonderegger" 1 => "S. Gidwani" 2 => "M. Ross" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Hand Surg Eur Vol" "fecha" => "2012" "volumen" => "27" "paginaInicial" => "244" "paginaFinal" => "250" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Posterior interosseous island forearm flap" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.A. Zancolli" 1 => "C. Angrigiani" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Br" "fecha" => "1988" "volumen" => "13" "paginaInicial" => "130" "paginaFinal" => "135" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3385286" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The anatomic basis of the fascio-cutaneous flap of the posterior interosseous artery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.V. Penteado" 1 => "A.C. Masquelet" 2 => "J.P. Chevrel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Surg Radiol Anat" "fecha" => "1986" "volumen" => "8" "paginaInicial" => "209" "paginaFinal" => "215" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3107143" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of posttraumatic radioulnar synostosis with excision and low-dose radiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.A. Abrams" 1 => "B.P. Simmons" 2 => "R.A. Brown" 3 => "M.J. Botte" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0363-5023(93)90322-T" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "1993" "volumen" => "18" "paginaInicial" => "703" "paginaFinal" => "707" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8349985" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of traumatic radioulnar synostosis by excision and postoperative low-dose irradiation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.P. Cullen" 1 => "V.D. Pellegrini" 2 => "R.J. Miller" 3 => "J.A. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/0363-5023(94)90051-5" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "1994" "volumen" => "19" "paginaInicial" => "394" "paginaFinal" => "440" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8056964" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cross-union complicating fractures of the forearm. Part I: Adults" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.G. Vince" 1 => "J.E. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1987" "volumen" => "69A" "paginaInicial" => "640" "paginaFinal" => "653" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-traumatic proximal radio-ulnar synostosis: results of surgical treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.M. Failla" 1 => "P.C. Amadio" 2 => "B.F. Morrey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1989" "volumen" => "71" "paginaInicial" => "1208" "paginaFinal" => "1213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2777849" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proximal radial resection for posttraumatic radioulnar synostosis: a new technique to improve forearm rotation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Kamineni" 1 => "N.G. Maritz" 2 => "B.F. Morrey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2002" "volumen" => "84" "paginaInicial" => "745" "paginaFinal" => "751" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12004015" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000005800000002/v1_201403190006/S1988885614000224/v1_201403190006/en/main.assets" "Apartado" => array:4 [ "identificador" => "7586" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005800000002/v1_201403190006/S1988885614000224/v1_201403190006/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885614000224?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 0 | 6 |
| 2024 October | 44 | 2 | 46 |
| 2024 September | 66 | 11 | 77 |
| 2024 August | 70 | 9 | 79 |
| 2024 July | 41 | 7 | 48 |
| 2024 June | 55 | 3 | 58 |
| 2024 May | 37 | 14 | 51 |
| 2024 April | 54 | 14 | 68 |
| 2024 March | 73 | 9 | 82 |
| 2024 February | 91 | 13 | 104 |
| 2024 January | 109 | 9 | 118 |
| 2023 December | 110 | 12 | 122 |
| 2023 November | 110 | 13 | 123 |
| 2023 October | 168 | 7 | 175 |
| 2023 September | 108 | 10 | 118 |
| 2023 August | 135 | 6 | 141 |
| 2023 July | 138 | 13 | 151 |
| 2023 June | 121 | 10 | 131 |
| 2023 May | 160 | 6 | 166 |
| 2023 April | 131 | 3 | 134 |
| 2023 March | 89 | 4 | 93 |
| 2023 February | 59 | 4 | 63 |
| 2023 January | 78 | 8 | 86 |
| 2022 December | 68 | 10 | 78 |
| 2022 November | 54 | 10 | 64 |
| 2022 October | 69 | 14 | 83 |
| 2022 September | 81 | 7 | 88 |
| 2022 August | 79 | 17 | 96 |
| 2022 July | 81 | 11 | 92 |
| 2022 June | 79 | 5 | 84 |
| 2022 May | 58 | 12 | 70 |
| 2022 April | 52 | 16 | 68 |
| 2022 March | 91 | 9 | 100 |
| 2022 February | 39 | 9 | 48 |
| 2022 January | 75 | 12 | 87 |
| 2021 December | 39 | 15 | 54 |
| 2021 November | 58 | 13 | 71 |
| 2021 October | 63 | 15 | 78 |
| 2021 September | 63 | 14 | 77 |
| 2021 August | 63 | 6 | 69 |
| 2021 July | 55 | 9 | 64 |
| 2021 June | 32 | 10 | 42 |
| 2021 May | 22 | 8 | 30 |
| 2021 April | 53 | 6 | 59 |
| 2021 March | 22 | 9 | 31 |
| 2021 February | 11 | 13 | 24 |
| 2021 January | 10 | 4 | 14 |
| 2020 December | 1 | 0 | 1 |
| 2019 September | 2 | 0 | 2 |
| 2018 February | 31 | 1 | 32 |
| 2018 January | 89 | 3 | 92 |
| 2017 December | 61 | 1 | 62 |
| 2017 November | 34 | 3 | 37 |
| 2017 October | 37 | 1 | 38 |
| 2017 September | 28 | 7 | 35 |
| 2017 August | 42 | 5 | 47 |
| 2017 July | 34 | 4 | 38 |
| 2017 June | 40 | 10 | 50 |
| 2017 May | 42 | 5 | 47 |
| 2017 April | 29 | 1 | 30 |
| 2017 March | 21 | 20 | 41 |
| 2017 February | 40 | 4 | 44 |
| 2017 January | 31 | 4 | 35 |
| 2016 December | 41 | 6 | 47 |
| 2016 November | 36 | 4 | 40 |
| 2016 October | 72 | 5 | 77 |
| 2016 September | 72 | 6 | 78 |
| 2016 August | 24 | 7 | 31 |
| 2016 July | 19 | 5 | 24 |
| 2016 June | 18 | 6 | 24 |
| 2016 May | 23 | 14 | 37 |
| 2016 April | 13 | 17 | 30 |
| 2016 March | 14 | 14 | 28 |
| 2016 January | 0 | 1 | 1 |
| 2015 December | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
| 2014 April | 2 | 1 | 3 |
Show all
