1,720,964 research outputs found
Retrograde intramedullary headless compression screw fixation for pediatric mid-diaphyseal proximal phalanx malunion: A case study
No full textIntroduction: Proximal phalanx fractures in children, especially mid-diaphyseal fractures, can result in malunion and significant functional impairment. Early malunions require prompt and effective intervention to prevent long-term complications. This case study highlights the use of intramedullary headless compression screw (IMHCS) fixation in addressing a proximal phalanx malunion. Case presentation: A 12-year-old boy presented with a malunion of the mid-diaphyseal proximal phalanx of the fourth finger following conservative treatment of a cycling injury. Initial management involved immobilization followed by buddy taping; however, incomplete radiographic evaluation resulted in an underestimation of the volar angulation. At the four-week follow-up, the patient exhibited 50 degrees volar angulation, clinodactyly, and marked stiffness. The malunion was treated surgically with retrograde IMHCS fixation after osteoclasis. Radiographic evaluation confirmed proper reduction and alignment. The patient began physical therapy immediately, achieved full range of motion within four weeks and maintained excellent functional outcomes at one year postoperatively. Discussion: Retrograde IMHCS fixation is an innovative technique for managing phalangeal malunions, providing stable fixation and enabling early mobilization. This method avoids the physis, minimizing the risk of growth disturbances, eliminates the need for hardware removal, and ensures proper alignment. Conclusion: IMHCS fixation is a promising solution for early malunions and potentially fresh fractures of the proximal phalanx in pediatric patients. It offers stable fixation, preserves physeal integrity, and supports early rehabilitation, contributing to excellent functional recovery. Further studies are needed to evaluate its long-term outcomes.The authors wish to thank the Department of Orthopaedics at AZ Delta Roeselare, Belgium for their assistance in this manuscript
Corrigendum to “Ultrasound imaging: Enhancing the diagnosis of carpal tunnel syndrome” [J Hand Microsurgery, (17), Issue 1, January 2025, 100173]
No full textUltrasound imaging: Enhancing the diagnosis of carpal tunnel syndrome
No full textBroader adoption of ultrasound (US) imaging in carpal tunnel syndrome management enhances patient care and outcome. This case underscores the importance in diagnosing carpal tunnel syndrome, highlighting its capability to uncover hidden anomalies and assist in surgical planning
Advantages of saving carpal height in hand replantation surgery
No full textA wrist-level amputation is often referred to as a good indication for replantation surgery and the functional outcome mainly depends on the amputation mechanism. 1 Should one preserve the proximal carpal row in replantation surgery after a wrist-level amputation? Bone shortening, usually performed by a proximal row carpectomy is generally considered to be a critical step in wrist replantation, since it facilitates radical debridement of the soft tissues and direct repair of the neurovascular structures. 2 This dilemma became eminent when we successfully replanted a trans scaphoid midcarpal guillotine-type amputation of the right hand in a right-dominant female of 29 years old in 2011. In our opinion, clear cut amputations at the level of the wrist, whether they occurred through the radiocarpal or the midcarpal joint, are the exception to this rule! The amputation was caused by a direct blow of the front loader of a tractor and replantation surgery was initiated 2 h after trauma while the revascularization occurred within a four-hour time frame. The bony fixation was performed with a headless compression screw to the scaphoid and an external fixation device to the wrist. The post-operative recovery was uneventful, and an intensive, functional rehabilitation was given by experienced hand therapists. After six months, a surgical tenolysis was necessary to improve further functional finger motion of the fifth finger. The recovery of the ulnar nerve occurred surprisingly quick, while thenar atrophy persisted. Remarkable, repeated electro-myographic examinations of the median and ulnar nerve revealed near normal motor nerve conduction. From an osteo-articular point of view, radiographic consolidation of the scaphoid occurred within 3 months after surgery. In the decade following the initial trauma, progressive narrowing of the midcarpal joint space-especially at the level of the capito-lunate joint-was seen on regular X-rays and was confirmed by CAT scan examination (Fig. 1(c-d-i)). A plausible explanation of this inevitable evolution was that of an obvious mid-carpal instability. Since the patient experienced no discomfort, pain or functional deterioration no surgical intervention was proposed. The range of motion, functional recovery and painless neurovascular state were striking. Our patient was tested 10 years postoperatively by an experienced hand therapist (not involved in the postoperative rehab). The active wrist mobility was 60 palmar flexion, 40 dorsal extension 20 radial, 10 ulnar deviation and the pro/supination were 90. The total active range of motion for the thumb was 65 and 215 on average for the long fingers. The maximum grip force was 18 kg (10 kg less than the contralateral side), and the pinch positions showed a maximum force between 1.5kg and 3.25kg (54%-70% less than the healthy side). The full DASH demonstrated a score of 31.6. The MHQ for the overall hand function was 20%, the activities of daily living for the injured hand scored 5% while it was 67% for both hands. The scores for work performance and pain were respectively 80% and 60%. The aesthetics and satisfaction of the injured hand scored respectively 93% and 33%. The surgical strategy proved to obtain a long-lasting result! Currently, there is no agreement about shortening or fixing the bone in wrist replantation. 3,4 For amputations at the distal forearm, plate and screw fixation is advocated, Kirschner wire fixation is preferred at radi-ocarpal joint level and in cases of a midcarpal amputation, a proximal row carpectomy is recommended. A critical footnote is appropriate when considering the consensus about the necessity to shorten in replantation surgery. Restoring the original bony anatomy is more straight forward and an acceptable long-term outcome is to be expected. Moreover, if eventual evolutive degeneration of the midcarpal joint with consequen-tial functional deterioration occurs, options are available to preserve wrist motion. Secondary procedures like a four-corner fusion and even a proximal row carpectomy, can be considered to deal with the installing instability and arthritis and postpone the necessity to perform more radical procedures like a wrist arthrodesis. We believe that in a guillotine-type amputation through the midcarpal joint, avoiding bone shortening and thus preserving length, is the better option!We thank Jan Noyez MD and Veerle Degryse PT for their assistance
and guidance in this researc
Revision options for discontinued trapeziometacarpal arthroplasties: compatibility with currently available implants
No full textSurgical revision options for failed trapeziometacarpal total joint replacement include implant replacement and trapeziectomy. However, discontinuation of older implants complicates revision with original components, particularly as removing a well-fixed metacarpal stem can be challenging. This study examined the feasibility of pairing discontinued stems (Arpe, Elektra and Ivory) with currently available necks (Ma & iuml;a, Moovis and Touch). We analysed the metallurgical composition, insertion depth, contact surface area and mechanical stability for all possible combinations of these implants. Our findings show compatibility of both Ivory and Arpe stems with the Touch neck and of the Elektra stem with the Moovis neck. Under strict lateral loading, fixation was stable up to 826.87 N, surpassing in vivo forces. Microscopic evaluation after the biomechanical load-to-failure test showed negligible damage to the connecting surfaces. These results suggest that it is safe to pair discontinued stems with currently available necks in revision trapeziometacarpal total joint arthroplasty.Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Acknowledgements
The authors wish to thank Koen Libens for his assistance in mechanical stability testing
Digital mucous cysts of the finger without osteoarthritis: optimizing outcome of long needle trajectory aspiration and injection
No full textDigital mucous cysts are common, benign and highly recurrent tumors of the distal interphalangeal joints of the fingers and often associated with osteoarthritis. Multiple treatment modalities have been described, but still no consensus is stated. In the absence of degenerative changes, we promote a novel non-surgical approach. The aim of this study was to examine all patients with digital mucous cysts without underlying osteoarthritis, undergoing this injection technique and to assess outcome and complications of this procedure. This was a single center study (2018-2019) of 17 patients who received a long needle trajectory aspiration and injection for treatment of digital mucous cysts. Exclusion criteria were prior surgical treatment, post-traumatic cyst formation and the presence of radiographic distal interphalangeal joint osteophytosis. A total of 15 patients were found eligible for inclusion. The patient reports were retrospectively analyzed with a follow-up of 6 months. The primary study outcome was resolution of the cyst; secondary outcomes were complications of the procedure. Twelve (80%) resolved completely and three (20%) had limited local recurrence at 6 months. No complications were reported. None of the patients with limited recurrence desired further treatment. We believe that this technique offers a non-invasive, low-cost treatment option for digital mucous cysts, particularly in the subset of patients with ample evidence of degenerative articular changes in the distal interphalangeal joint. The described technique can be performed in an office-based setting and avoids typical surgical as well as aspiration-associated complications
Shortening arthrodesis combined with limited fasciectomy in severe recurrent Dupuytren's disease of the fifth finger
No full textObjective: Management of recurrent Dupuytren's disease of the little finger is challenging. Various treatment modalities have been proposed: external fixation, local skin flap, dermofasciectomy, or even amputation. An alternative surgical technique was introduced by Honecker et al. in 2016 and refined by Raimbeau et al. in 2019, consisting in resection of the middle phalanx and shortening arthrodesis. We modified the technique by combining arthrodesis with a limited fasciectomy of the abductor and/or pretendinous cord in the fifth ray to improve cosmetic and functional outcomes. Methods: Patients with severe recurrent Dupuytren's disease of the little finger (Tubiana stage III/IV) were treated with proximodistal interphalangeal arthrodesis, combined with limited fasciectomy. Range of motion was assessed preoperatively and postoperatively. QuickDASH and a VAS were assessed to determine overall function and pain respectively. Radiographic evaluation was made at 6 and 12 weeks postoperatively. Results: Thirteen patients were eligible for inclusion. Mean age was 69 years (range 49–87). Radiographic consolidation was obtained at a mean 58 days (range 27–97). Full extension of the metacarpophalangeal joint was achieved in 11 patients and full adduction in 12. Mean active flexion was 94° (range 90–100). QuickDASH scores decreased from 18 to 12 after surgery. Pain scores were low and unchanged. Conclusion: By combining proximodistal interphalangeal arthrodesis with limited fasciectomy through a volar approach, finger extension improved, and fixed abduction was also treated. The combined volar and dorsal approach did not induce vascular impairment or other complications
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
- …
