1,721,005 research outputs found
Outcomes of Distal Ulna Fractures Associated With Operatively Treated Distal Radius Fractures
Full text linkBackground: The purpose of this study was to report outcomes in patients with nonstyloid distal ulna fractures treated in conjunction with open reduction internal fixation (ORIF) of distal radius fractures. Methods: A retrospective review of all patients who had undergone ORIF of a distal radius fracture over a 5-year period at a single institution was performed. Radiographic review was performed to identify patients with a concomitant fracture of the distal ulna. Radiographs were examined to determine whether and how the distal ulna fracture was stabilized and to assess healing of the distal ulna. Range of motion (ROM) was determined by review of the patients' charts. All skeletally mature patients with distal ulna fractures (not including isolated styloid fractures) undergoing surgical fixation of the distal radius fracture were included. Patients were excluded if follow-up was inadequate. There were 172 fractures of the distal ulna meeting the inclusion criteria. Seven patients were excluded. There were 91 patients treated without ulna fixation (ulna-no) and 74 patients treated with ulna fixation (ulna-yes). Results: Seventy-two (97%) of the ulna-yes patients healed. All patients in the ulna-no group healed. The only significant difference in ROM was in pronation, although the magnitude of this difference was relatively small. Conclusions: Fractures of the distal ulna have high rates of healing and result in equivalent motion regardless of whether the distal ulna is treated operatively. Routine surgical fixation of concomitant distal ulna fractures during distal radius ORIF does not appear to be necessary
Chapter 53: Distal Radius Osteotomy for Malunion: Dorsal Approach
No full textDistal radius osteotomy can help restore the anatomic parameters of the distal radius when fractures heal in an incorrect position. Various surgical techniques have been described to perform a corrective osteotomy of a distal radius malunion. We describe herein a dorsal approach to correct bony deformity
Chapter 27: Endoscopic Ulnar Nerve Decompression
No full textEndoscopic cubital tunnel release is a minimally invasive procedure
that relieves the compression on the ulnar nerve as it
passes through the cubital tunnel. When conservative treatment
fails, this procedure is used to relieve the pressure on the
ulnar nerve
Effectiveness of Ponseti Method for the Treatment of Congenital Talipes Equinovarus: Personal Experience
No full textCongenital talipes equinovarus, also known as clubfoot, is a relatively common skeletal deformity characterized
by an excessively turned-in foot and a high medial longitudinal arch.
Three different forms of this disorder have been identified: positional or postural, idiopathic, and teratogenic or
syndromic. The etiopathogenesis of this anomaly is not clearly known. Two genes, PITX-1 and RBM-10, have
recently been reported to play direct or indirect roles in the pathogenesis of clubfoot. Clinical diagnosis is at a
glance; X-ray analysis is initially unnecessary but should be used after treatment to follow the outcome.
Various surgical or nonsurgical methods of treatment have been applied to treat this disorder, including the Kite,
Cincinnati, Bensahel/Dimeglio, and Turco techniques. Actually the Ponseti method has been considered the gold
standard technique for treatment of this disorder.
We treated 132 children affected by clubfoot using the Ponseti method, with good/excellent results in 94% of the
treated feet. Our experience confirms the effectiveness of the Ponseti method in the treatment of clubfoot
Morphometric Assessment of the Residual Width of the Distal Hamate Articular Surface after Graft Harvest for Hemi-hamate Arthroplasty
No full textBackground: The hemi-hamate arthroplasty (HHA) can restore joint congruity and stability in chronic fracture-dislocations of the proximal interphalangeal joint (PIPJ). Purpose of this study was to compare the width of the distal hamate articular surface (DHAS) to the width of the base of the middle phalanges (P2) of the fingers. We hypothesized the dimensions of the width of the DHAS would be similar to those of P2, leaving a small amount of residual DHAS width after autograft harvest. Methods: Fifty-nine CT scans of the hand without any bony pathology were evaluated. Three observers measured the following parameters and compared: (a) Width of the DHAS in the axial and coronal planes; (b) Width of the P2 articular bases of all four fingers; (c) Maximum capitate length (MaxCap) in the coronal plane. Results: The residual DHAS on the coronal plane after graft harvest (bone remaining on the radial and ulnar aspects each, not accounting for saw blade or osteotomy width thickness) among all patients was 1.3, 0.9, 1.4, and 2.4 mm for the index, long, ring and small fingers respectively. There was a strong correlation between DHAS and MaxCap r=0.76. Conclusion: There is likely to be a very small amount of residual hamate articular surface width left after the graft is harvested if the entire base of P2 is reconstructed
The Effect of Intraoperative Corticosteroid Injections on the Risk of Surgical Site Infections for Hand Procedures
No full textPurpose The aim of the study was to assess the risk of surgical site infection (SSI) in patients
who received an intraoperative injection (IOI) with a corticosteroid at the same time as hand
surgery for a different condition.
Methods This was a retrospective chart review of all patients who underwent hand surgery and
corticosteroid injections concurrently over an 8-year period. Comparison of the rates of SSI
was made of patients who had received an IOI and a matched control cohort of patients with
no intraoperative injection (nIOI). There were 391 patients in each group.
Results There were 8 SSIs in the IOI group compared with 2 in the nIOI group. One patient in
the IOI group had a deep infection whereas all other infections were superficial. In the IOI
group, 206 patients had injections on the side ipsilateral to their surgical procedure. Six of
these patients had SSIs, a significant difference compared with the control group. There were
185 patients who had contralateral injections. Two of these patients had SSIs. Compared with
the control group, this difference was not significant.
Conclusions Concomitant injection of steroid into the same side as the surgical site increases
the risk of postoperative infection. We do not recommend administering a corticosteroid
injection at the time of hand surgery
The Importance of Staging Arthroscopy for Chondral Defects of the Knee
No full textThis study aims to evaluate the role of staging arthroscopy in the diagnosis of knee chondral defects and subsequent surgical planning prior to autologous chondrocyte implantation (ACI), osteochondral allograft transplantation (OCA), and meniscus allograft transplantation (MAT). All patients who underwent staging arthroscopy prior to ACI, OCA, or MAT at our institution from 2005 to 2015 were identified. Medical records were reviewed to document the diagnosis and treatment plan based on symptoms, magnetic resonance imaging (MRI) findings and previous operative records. Operative records of the subsequent staging arthroscopy procedure were reviewed to document the proposed treatment plan after arthroscopy. All changes in treatment plan following staging arthroscopy were recorded. Univariate analyses were performed to identify any significant predictors for likelihood to change. A total of 98 patients were included in our analysis. A change in surgical plan was made following arthroscopy in 36 patients (36.7%). Fourteen patients (14.3%) were found to have additional defects that warranted cartilage restoration surgery. In 15 patients (15.3%), at least one defect that was originally thought to warrant cartilage restoration surgery was found to be amenable to debridement alone. The surgical plan was changed from ACI to OCA in four cases (4.1%) and OCA to ACI in one case (1%). A previously proposed MAT was deemed unwarranted in one case (1%), and a planned meniscal repair was changed to MAT in another (1%). Patient age, sex, and the affected knee compartment were not predictors for a change in surgical plan. Body mass index (BMI) was significantly higher in patients who had a change in surgical plan (29.5 kg/m2) compared with those who did not (26.5 kg/m2). A change in surgical plan was more likely to occur for trochlear lesions (46.4%) compared with other articular surface lesions (p = 0.008). The results of our study indicate that staging arthroscopy is an important step in determining the most appropriate treatment plan for chondral defects and meniscal deficiency, particularly those with trochlear cartilage lesions
The Importance of a Correct Diet in Preventing Osteoporosis
No full textOsteoporosis is a very common bone disease characterized by low bone mass and micro architectural deterioration
of bone tissue. It may result in high risk of bone fractures with impaired quality of life. The prevention of this disorder
is based on an appropriate lifestyle and a proper diet. The correct supply of Vitamins D and K, protein, fatty acids and
dietary components are notable factors that help maintain healthy bone structure. The effects of these elements have
been briefly discussed and they have been shown to correlate to bone health
Fracture of an Os Hamulus Proprium: A Case Report
No full textCase: We report the case of a 39-year-old man who sustained an acute fracture of an os hamulus proprium, which was treated with open surgical excision after nonoperative treatment was unsuccessful. At the most recent follow-up, at 6 years after surgery, the patient was asymptomatic and maintained full function of the hand and the wrist.
Conclusion: An os hamulus proprium is often confused with a fracture of the hook of the hamate, and little information exists in the literature regarding these accessory ossicles. To our knowledge, an os hamulus proprium fracture has not previously been described in the literature
Post-operative Opioid, Benzodiazepine and Sedative Usage in Medicare versus Commercial Insurance Hand Surgery Patients
No full textBackground:
Opioid usage has increased in recent years. The purpose of this study is to assess post-operative opioid, sedative, and benzodiazepine usage in a Medicare population.
Methods:
Consecutive patients undergoing elbow, wrist, and hand surgery by hand surgeons at one academic outpatient surgical center were prospectively enrolled. Patients were excluded if they were minors or if they underwent more than one surgical procedure during the study period. There were 269 patients enrolled, and this group was divided by insurance type into younger commercial insurance (CI) and older Medicare (MC) groups.
The Pennsylvania Physician Drug Monitoring Program website was used to document all prescriptions of controlled substances filled six months prior to and after the surgical procedure.
Results:
The mean age in the CI group was 45.8 years (range: 16-88) and 69.2 years (range: 43-91) in the MC group. Postoperatively, the CI patients filled significantly less opioid prescriptions than the MC group, 1.10 vs. 1.79. Patients in the CI group were given an average of 0.3 benzodiazepine prescriptions before surgery and 0.2 after surgery. Patients in the MC group were given 0.6 prescriptions before and 0.5 prescriptions of benzodiazepines after surgery. The CI group was given an average of 0.1 sedative/hypnotic prescriptions before surgery and 0.1 after surgery. The MC group was given 0.7 prescriptions before and 0.4 prescriptions of sedative/hypnotics after surgery.
There were 0.17 prescriptions per patient in the CI group and 0.75 per patient in the MC group (P <.05). Twenty-two of 208 (10.6%) of CI and 16/61 (26.2%) of MC patients filled a prescription between 3-8 months post-operatively.
Conclusion:
Prolonged use of opioid, benzodiazepine and sedative medications is common after upper extremity surgical procedures. Older patients are also at risk, and may be even more likely than younger patients to use these medications post-operatively
- …
