Ricardo Monreal - Academia.edu (original) (raw)

Papers by Ricardo Monreal

HAL (Le Centre pour la Communication Scientifique Directe), 2020

Nucleation and Atmospheric Aerosols, 2004

Even though the use of ultrasound in medicine is better known by its results in diagnostic proced... more Even though the use of ultrasound in medicine is better known by its results in diagnostic procedures, the employ of this type of mechanical energy with therapeutic purposes is been used in new and impressive applications. To obtain or to improve tissue healing in many ailments it is used a lot of approaches, from the employ of antibiotics when it is considered by the presence of an infection in the wound, to several types of physical stimulation. One of them is ultrasound. This paper consider some of the most important mechanisms of action of ultrasound in tissue that can be related whit the repair processes and specifies levels of activation of many paths of action. Especial emphasis has received the stimulation of bone repair by ultrasound.

Orthopedics and rheumatology, Jul 20, 2021

Background: Proximal humeral fractures account for 4-6% of all fractures and 25% of humeral fract... more Background: Proximal humeral fractures account for 4-6% of all fractures and 25% of humeral fractures. Proximal humerus fractures are very common and often accompanied by osteoporosis in elderly population. The external fixation is one of the surgical options to treat proximal humeral fractures. The aim of this study is to evaluate the clinical and radiological results of osteosynthesis by close reduction and external fixation in the management of displaced proximal humerus fractures in elderly population. Material and Methods: From Jan 2012 through December 2015, five elderly adult patients (≥60 years) with displaced proximal humeral fracture were treated by close reduction and external fixation using the FERN ™external fixation frame. Radiograph was used to evaluate bony union, wires migration, and fragment displacement. Clinical outcomes were evaluated the 1-10 visual analog score (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES). Results: Regarding the clinical outcomes at the final follow up, the means of the visual analogue scale (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) of the injured shoulders were 0.8 (range, 0-2), and 90.6 (range, 81-97) respectively. Radiographic bony union were noted, and external fixators were removed at 47,3± 2,9 days (range 40-63). Nonunion, implant failure, or avascular necrosis of the humeral head were observed during the follow-up. Conclusion: Osteosynthesis with external fixator can be considered today as a valid treatment for proximal humeral fractures in elderly patients. The results in terms of functional recovery are encouraging with a reduced risk of complications.

Juniper online journal of orthopedic & orthoplastic surgery, Apr 10, 2017

Vascularized bone graft is a well-accepted technique when dealing with long defects. In this pape... more Vascularized bone graft is a well-accepted technique when dealing with long defects. In this paper the author presents a case with a chronically infected gap nonunion of the proximal ulna treated with a free vascularized fibular graft. Vascularized fibular graft is a reliable technique for reconstruction of bone defects of the forearm even in the presence of infection.

Orthopedics and rheumatology, Jul 19, 2017

Operative technique Under general anesthesia or regional axillary anesthesia, a short longitudina... more Operative technique Under general anesthesia or regional axillary anesthesia, a short longitudinal dorsal incision (4-5 cm) is centered over the distal carpal row to reach the insertion of the ECRB on

Orthopedics and Rheumatology Open Access Journal

Introduction: Proximal fibular osteotomy (PFO) is a surgical procedure to treat osteoarthritis in... more Introduction: Proximal fibular osteotomy (PFO) is a surgical procedure to treat osteoarthritis involving the medial compartment of knee. PFO provides pain relief and delays the progression of degenerative changes. Patients and Methods: The present study included assessment radiological and functional outcomes of proximal fibular osteotomy in medial knee osteoarthritis. Three consecutive patients who underwent PFO were followed retrospectively. Results: Medial pain relief was observed in all patients after PFO. Radiographs of the weight-bearing lower extremity showed an average increase in the medial knee joint space postoperatively compared with preoperatively. Conclusion: PFO is a simple, safe, and fast surgical procedure to relieve pain and achieving improvement in knee function and it is a promising alternative for osteoarthritis of the medial compartment of the knee, for patients who cannot undergo or it necessary to delay total knee arthroplasty because of certain medical comorbidities. It may also constitute an alternative in developing countries because of their financial and healthcare delivery limitations.

Orthopedics and Rheumatology Open Access Journals, 2019

Juniper Online Journal of Orthopedic and Orthoplastic Surgery, 2017

To present a random-pattern flap technique using pedicle ultra-thin abdominal flap used in the re... more To present a random-pattern flap technique using pedicle ultra-thin abdominal flap used in the reconstruction of soft tissue defects of the hand in an attempt to avoid the bulky abdominal flap, and minimizing the donor site morbidity of abdominal flap. Patients and Methods: Between 2013 and 2016, six male patients with hand defects received reconstructive surgery. Hand defects were in the form of mutilating hand injuries that leave a "good" thumb. The flaps were elevated ultra-thin, keeping a very thin layer of fat that ensures the existence of the sub dermal plexus. All the flaps were divided after 15 days. Results: All flaps gave a satisfactory coverage with excellent contouring, and did not require revision. Conclusion: Ultra-thin abdominal flap is safe, easy to harvest, has no donor site morbidity, and does not require a secondary debulking surgery.

Orthopedics and Rheumatology Open Access Journal, 2016

Acetabular fractures treatment represents a great controversy for an orthopedic surgeon. Displace... more Acetabular fractures treatment represents a great controversy for an orthopedic surgeon. Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. In spite of advances made in the operative management, conservative treatment is being followed in most of the centers in developing countries. There are previous studies reporting the long term outcome of conservatively treated acetabular fractures [1,2].

Orthopedics and Rheumatology Open access Journal, 2016

Complete or partial amputation of the thumb leads to considerable impairment in hand function [1,... more Complete or partial amputation of the thumb leads to considerable impairment in hand function [1,2] Preservation of length, soft tissue coverage and restoration of sensation are very important in the treatment of thumb injuries. In 1964, the volar advancement flap was first described by Moberg for the reconstruction of pulp defects of the thumb [3]. This flap is a pedicle advancement flap proximally based on an intact skin pedicle including both neurovascular bundles. This technique establishes a successful neurosensation of the pulp with a limited advancement as well. This article reports the outcome of a consecutive series of 10 patients to verify the advantages and disadvantages of the Moberg flap for coverage of palmar defects.

International Orthopaedics, 2017

Purpose Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip... more Purpose Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. Materials and methods In this retrospective study, nine consecutive patients who sustained mutilating ring finger injury were managed by fourth ray amputation with fifth ray transposition between January 2008 and December 2014. There were six males and three females with a mean age of 30.2 ± 12.2 years (age range, 16-56 years) at the time of surgery who underwent delayed fourth ray amputation with fifth ray transposition (after 14 days of injury). Eight cases had undergone previous surgical interventions: three ORIF using intramedullary K-wire fixation, one failed reimplantation, four debridement and application of split thickness skin graft. Primary skin closure of the amputated finger was not considered as previous surgery (one patient). Results All patients were followed up for a mean period of 17.1 ± 4.1 months (range, 12-24 months). Grip strength and RAS score improved after fourth ray resection. The postoperative grip strength and RAS (score) were not compromised by the associated hand dominance. Conclusion The following conclusions can be made despite the fact that this was a limited study as well as a retrospective analysis: 1-In technical terms, resection of the fourth ray with transposition of the small finger with a wedge-shaped hamatecapitate arthrodesis secured by screw fixation is easier than metacarpal osteotomy/transposition and less liable to postoperative complications. 2-The results of this study suggest that fourth ray resection and transposition of the small finger with a hamate-capitate arthrodesis restores hand function and cosmetics.

Journal of brachial plexus and peripheral nerve injury, Jan 12, 2007

After severe brachial palsy involving the shoulder, many different muscle transfers have been adv... more After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injured; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41), the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years) and the average follow-up was 17.5 months (range 6 to 52), reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the result...

El empleo de una señal de ultrasonido pulsado de baja intensidad ha estado demostrando a través d... more El empleo de una señal de ultrasonido pulsado de baja intensidad ha estado demostrando a través de numerosas pruebas clínicas, ser un eficaz método para la estimulación de la reparación ósea. Este trabajo presenta los resultados obtenidos en un estudio preliminar efectuado en el "Hospital Docente Comandante Manuel Fajardo", en La Habana, Cuba, entre los años 1999 y el 2000, sobre el tratamiento de fracturas óseas con retardo en su proceso de curación, tratadas mediante una terapia por ultrasonidos. Un total de 11 fracturas con diferentes tiempos de evolución fueron tratadas diariamente por un periodo de 20 minutos, con una señal ultrasónica de 30 mW/cm 2 (promedio espacialpromedio temporal), 1 MHz, sinusoidal pulsada en paquetes de 400 µs de duración y repetidos con una frecuencia de 0.5 kHz. El tratamiento fue empleado hasta que la fractura fue encontrada tanto clínicamente como radiológicamente curada. Ningún tratamiento falló.

Orthopedics and Rheumatology Open Access Journal, Sep 13, 2019

Purpose: Treatment of traumatic sagittal band injury and subluxation of the extensor tendon at th... more Purpose: Treatment of traumatic sagittal band injury and subluxation of the extensor tendon at the metacarpophalangeal joint is often conservative but can also require surgical intervention if conservative treatment fails. A technique is presented using an extensor digitorum communis (EDC) tendon slip to stabilize the dislocated extensor tendon. Methods: Nine patients (7 males and 2 females) with persistent pain and traumatic or spontaneous extensor tendon subluxations (> 6 weeks) in non-rheumatic hand underwent surgery. Results: In all patients the EDC tendon demonstrated pain-free stability without subluxation on metacarpophalangeal joint flexion, with a full range of motion (ROM) of the metacarpophalangeal (MCP) joint. Conclusion: Restoration of sagittal band stability and extensor tendon centralization at the metacarpophalangeal joint by the extensor slip loop technique recreate the physiologic biomechanical forces.

Orthopedics and Rheumatology Open Access Journal, 2017

The purpose of this article is to report radiographic, clinical, and functional outcome of a 52 y... more The purpose of this article is to report radiographic, clinical, and functional outcome of a 52 year old woman who sustained an open comminuted and unstable fracture of the distal part of the right radius treated with early debridement and external fixation.

Orthopedics and Rheumatology Open Access Journal, 2017

Damage control orthopaedics has proven to be a powerful tool for the orthopedic surgeon who treat... more Damage control orthopaedics has proven to be a powerful tool for the orthopedic surgeon who treats an unstable trauma victim or a patient in extremis and for the borderline patient as well. A limited form of damage control orthopaedics (limb damage control orthopaedics) is a rational alternative for the treatment of isolated, complex limb injuries.

Orthopedics and Rheumatology Open Access Journal, 2017

HAL (Le Centre pour la Communication Scientifique Directe), 2020

Nucleation and Atmospheric Aerosols, 2004

Even though the use of ultrasound in medicine is better known by its results in diagnostic proced... more Even though the use of ultrasound in medicine is better known by its results in diagnostic procedures, the employ of this type of mechanical energy with therapeutic purposes is been used in new and impressive applications. To obtain or to improve tissue healing in many ailments it is used a lot of approaches, from the employ of antibiotics when it is considered by the presence of an infection in the wound, to several types of physical stimulation. One of them is ultrasound. This paper consider some of the most important mechanisms of action of ultrasound in tissue that can be related whit the repair processes and specifies levels of activation of many paths of action. Especial emphasis has received the stimulation of bone repair by ultrasound.

Orthopedics and rheumatology, Jul 20, 2021

Background: Proximal humeral fractures account for 4-6% of all fractures and 25% of humeral fract... more Background: Proximal humeral fractures account for 4-6% of all fractures and 25% of humeral fractures. Proximal humerus fractures are very common and often accompanied by osteoporosis in elderly population. The external fixation is one of the surgical options to treat proximal humeral fractures. The aim of this study is to evaluate the clinical and radiological results of osteosynthesis by close reduction and external fixation in the management of displaced proximal humerus fractures in elderly population. Material and Methods: From Jan 2012 through December 2015, five elderly adult patients (≥60 years) with displaced proximal humeral fracture were treated by close reduction and external fixation using the FERN ™external fixation frame. Radiograph was used to evaluate bony union, wires migration, and fragment displacement. Clinical outcomes were evaluated the 1-10 visual analog score (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES). Results: Regarding the clinical outcomes at the final follow up, the means of the visual analogue scale (VAS), and the American Shoulder and Elbow Surgeons Shoulder Score (ASES) of the injured shoulders were 0.8 (range, 0-2), and 90.6 (range, 81-97) respectively. Radiographic bony union were noted, and external fixators were removed at 47,3± 2,9 days (range 40-63). Nonunion, implant failure, or avascular necrosis of the humeral head were observed during the follow-up. Conclusion: Osteosynthesis with external fixator can be considered today as a valid treatment for proximal humeral fractures in elderly patients. The results in terms of functional recovery are encouraging with a reduced risk of complications.

Juniper online journal of orthopedic & orthoplastic surgery, Apr 10, 2017

Vascularized bone graft is a well-accepted technique when dealing with long defects. In this pape... more Vascularized bone graft is a well-accepted technique when dealing with long defects. In this paper the author presents a case with a chronically infected gap nonunion of the proximal ulna treated with a free vascularized fibular graft. Vascularized fibular graft is a reliable technique for reconstruction of bone defects of the forearm even in the presence of infection.

Orthopedics and rheumatology, Jul 19, 2017

Operative technique Under general anesthesia or regional axillary anesthesia, a short longitudina... more Operative technique Under general anesthesia or regional axillary anesthesia, a short longitudinal dorsal incision (4-5 cm) is centered over the distal carpal row to reach the insertion of the ECRB on

Orthopedics and Rheumatology Open Access Journal

Introduction: Proximal fibular osteotomy (PFO) is a surgical procedure to treat osteoarthritis in... more Introduction: Proximal fibular osteotomy (PFO) is a surgical procedure to treat osteoarthritis involving the medial compartment of knee. PFO provides pain relief and delays the progression of degenerative changes. Patients and Methods: The present study included assessment radiological and functional outcomes of proximal fibular osteotomy in medial knee osteoarthritis. Three consecutive patients who underwent PFO were followed retrospectively. Results: Medial pain relief was observed in all patients after PFO. Radiographs of the weight-bearing lower extremity showed an average increase in the medial knee joint space postoperatively compared with preoperatively. Conclusion: PFO is a simple, safe, and fast surgical procedure to relieve pain and achieving improvement in knee function and it is a promising alternative for osteoarthritis of the medial compartment of the knee, for patients who cannot undergo or it necessary to delay total knee arthroplasty because of certain medical comorbidities. It may also constitute an alternative in developing countries because of their financial and healthcare delivery limitations.

Orthopedics and Rheumatology Open Access Journals, 2019

Juniper Online Journal of Orthopedic and Orthoplastic Surgery, 2017

To present a random-pattern flap technique using pedicle ultra-thin abdominal flap used in the re... more To present a random-pattern flap technique using pedicle ultra-thin abdominal flap used in the reconstruction of soft tissue defects of the hand in an attempt to avoid the bulky abdominal flap, and minimizing the donor site morbidity of abdominal flap. Patients and Methods: Between 2013 and 2016, six male patients with hand defects received reconstructive surgery. Hand defects were in the form of mutilating hand injuries that leave a "good" thumb. The flaps were elevated ultra-thin, keeping a very thin layer of fat that ensures the existence of the sub dermal plexus. All the flaps were divided after 15 days. Results: All flaps gave a satisfactory coverage with excellent contouring, and did not require revision. Conclusion: Ultra-thin abdominal flap is safe, easy to harvest, has no donor site morbidity, and does not require a secondary debulking surgery.

Orthopedics and Rheumatology Open Access Journal, 2016

Acetabular fractures treatment represents a great controversy for an orthopedic surgeon. Displace... more Acetabular fractures treatment represents a great controversy for an orthopedic surgeon. Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. In spite of advances made in the operative management, conservative treatment is being followed in most of the centers in developing countries. There are previous studies reporting the long term outcome of conservatively treated acetabular fractures [1,2].

Orthopedics and Rheumatology Open access Journal, 2016

Complete or partial amputation of the thumb leads to considerable impairment in hand function [1,... more Complete or partial amputation of the thumb leads to considerable impairment in hand function [1,2] Preservation of length, soft tissue coverage and restoration of sensation are very important in the treatment of thumb injuries. In 1964, the volar advancement flap was first described by Moberg for the reconstruction of pulp defects of the thumb [3]. This flap is a pedicle advancement flap proximally based on an intact skin pedicle including both neurovascular bundles. This technique establishes a successful neurosensation of the pulp with a limited advancement as well. This article reports the outcome of a consecutive series of 10 patients to verify the advantages and disadvantages of the Moberg flap for coverage of palmar defects.

International Orthopaedics, 2017

Purpose Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip... more Purpose Loss of a fourth digit below the level of the proximal phalanx results in a weakened grip, loss of skilled movements, and the amputation stump is repeatedly traumatized. Transposition of an adjacent fifth digital ray can improve hand function and cosmetic appearance by closing the gap created by the missing digit. Digital ray amputation is not a commonly performed procedure. However, when performed correctly it can dramatically improve hand function and cosmesis. The aim of this study was to evaluate the functional and aesthetic results of the fifth ray radial translation and intercarpal arthrodesis in mutilating ring finger injuries. Materials and methods In this retrospective study, nine consecutive patients who sustained mutilating ring finger injury were managed by fourth ray amputation with fifth ray transposition between January 2008 and December 2014. There were six males and three females with a mean age of 30.2 ± 12.2 years (age range, 16-56 years) at the time of surgery who underwent delayed fourth ray amputation with fifth ray transposition (after 14 days of injury). Eight cases had undergone previous surgical interventions: three ORIF using intramedullary K-wire fixation, one failed reimplantation, four debridement and application of split thickness skin graft. Primary skin closure of the amputated finger was not considered as previous surgery (one patient). Results All patients were followed up for a mean period of 17.1 ± 4.1 months (range, 12-24 months). Grip strength and RAS score improved after fourth ray resection. The postoperative grip strength and RAS (score) were not compromised by the associated hand dominance. Conclusion The following conclusions can be made despite the fact that this was a limited study as well as a retrospective analysis: 1-In technical terms, resection of the fourth ray with transposition of the small finger with a wedge-shaped hamatecapitate arthrodesis secured by screw fixation is easier than metacarpal osteotomy/transposition and less liable to postoperative complications. 2-The results of this study suggest that fourth ray resection and transposition of the small finger with a hamate-capitate arthrodesis restores hand function and cosmetics.

Journal of brachial plexus and peripheral nerve injury, Jan 12, 2007

After severe brachial palsy involving the shoulder, many different muscle transfers have been adv... more After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injured; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41), the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years) and the average follow-up was 17.5 months (range 6 to 52), reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the result...

El empleo de una señal de ultrasonido pulsado de baja intensidad ha estado demostrando a través d... more El empleo de una señal de ultrasonido pulsado de baja intensidad ha estado demostrando a través de numerosas pruebas clínicas, ser un eficaz método para la estimulación de la reparación ósea. Este trabajo presenta los resultados obtenidos en un estudio preliminar efectuado en el "Hospital Docente Comandante Manuel Fajardo", en La Habana, Cuba, entre los años 1999 y el 2000, sobre el tratamiento de fracturas óseas con retardo en su proceso de curación, tratadas mediante una terapia por ultrasonidos. Un total de 11 fracturas con diferentes tiempos de evolución fueron tratadas diariamente por un periodo de 20 minutos, con una señal ultrasónica de 30 mW/cm 2 (promedio espacialpromedio temporal), 1 MHz, sinusoidal pulsada en paquetes de 400 µs de duración y repetidos con una frecuencia de 0.5 kHz. El tratamiento fue empleado hasta que la fractura fue encontrada tanto clínicamente como radiológicamente curada. Ningún tratamiento falló.

Orthopedics and Rheumatology Open Access Journal, Sep 13, 2019

Purpose: Treatment of traumatic sagittal band injury and subluxation of the extensor tendon at th... more Purpose: Treatment of traumatic sagittal band injury and subluxation of the extensor tendon at the metacarpophalangeal joint is often conservative but can also require surgical intervention if conservative treatment fails. A technique is presented using an extensor digitorum communis (EDC) tendon slip to stabilize the dislocated extensor tendon. Methods: Nine patients (7 males and 2 females) with persistent pain and traumatic or spontaneous extensor tendon subluxations (> 6 weeks) in non-rheumatic hand underwent surgery. Results: In all patients the EDC tendon demonstrated pain-free stability without subluxation on metacarpophalangeal joint flexion, with a full range of motion (ROM) of the metacarpophalangeal (MCP) joint. Conclusion: Restoration of sagittal band stability and extensor tendon centralization at the metacarpophalangeal joint by the extensor slip loop technique recreate the physiologic biomechanical forces.

Orthopedics and Rheumatology Open Access Journal, 2017

The purpose of this article is to report radiographic, clinical, and functional outcome of a 52 y... more The purpose of this article is to report radiographic, clinical, and functional outcome of a 52 year old woman who sustained an open comminuted and unstable fracture of the distal part of the right radius treated with early debridement and external fixation.

Orthopedics and Rheumatology Open Access Journal, 2017

Damage control orthopaedics has proven to be a powerful tool for the orthopedic surgeon who treat... more Damage control orthopaedics has proven to be a powerful tool for the orthopedic surgeon who treats an unstable trauma victim or a patient in extremis and for the borderline patient as well. A limited form of damage control orthopaedics (limb damage control orthopaedics) is a rational alternative for the treatment of isolated, complex limb injuries.

Orthopedics and Rheumatology Open Access Journal, 2017