1,721,014 research outputs found
Carpal Tunnel Syndrome Associated with Bifid Median Nerve and Palmaris Profundus - Case Report and Literature Review
Full text linkThe anatomic variations of the median nerve and of the muscles of the wrist have been widely reported in literature. It is essential for the surgeon to be familiar with these variations in order to avoid accidental injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by an anomalous tendon of palmaris profundus discovered during the surgical release of carpal tunnel. The transverse carpal ligament was dissected and the anomalous tendon was left in situ because any direct compression over the median nerve was noticed intraoperatively. The patient was evaluated one year postoperatively clinically and radiologically (with MRI). At the follow up the resolution of symptoms was complete and the sleep disturbance was solved. The patient achieved a postoperative QuickDASH score of 9.1 and a Michigan Hand Questionnaire outcome score of 90 points
Osteoporotic distal femur fractures in the elderly: Peculiarities and treatment strategies
No full textDistal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice. (www.actabiomedica.it)
Simultaneous bilateral olecranon fracture: A case report and review of the literature
No full textBackground and aim of the work: A bilateral fracture of the olecranon is a rare injury, with only few cases reported in the literature. Methods: A single case of bilateral Mayo type II A olecranon fracture in a 88 years old woman is described. A research of all articles regarding simultaneous bilateral olecranon fracture was performed in the PubMed database. Result: The reported case demonstrated good clinical and radiographic results at 5 months follow-up with surgical treatment. The literature search produced other 6 cases in 5 case reports. Except for one case of fatigue fracture that had been treated conservatively, the others received surgical treatment with satisfactory results. Conclusion: Simultaneous bilateral olecranon fracture is very uncommon. Bilateral internal fixation yields good clinical and radiographic results in most cases. (www.actabiomedica.it)
Post-operative periprosthetic humeral fractures after reverse shoulder arthroplasty: A review of the literature
No full textBackground and aim of the work: Post-operative periprosthetic shoulder fractures incidence is gradually raising due to aging of population and increasing of reverse total shoulder arthroplasty (RTSA). Management of this complication represents a challenge for the orthopedic surgeon. Aim of the present study is to critically review the recent literature about epidemiology, risk factors, diagnosis, management and outcome of post-operative periprosthetic humeral fractures occurring on RTSA. Methods: A systematic search of Em-base, Medline and Pubmed was performed by two reviewers who selected the eligible papers favoring studies published in the last ten years. Epidemiology, risk factors, diagnostic features, clinical management and outcome of different techniques were all reviewed. Results: 31 studies including reviews, meta-analysis, case reports, clinical and biomechanical studies were selected. Conclusions: Correct clinical management requires adequate diagnosis and evaluation of risk factors. Conservative treatment is rarely indicated. Locking plate fixation and revision arthroplasty are both valuable treatment methods. Surgical technique should be chosen considering age and functional demand, comorbidities, fracture morphology and location, bone quality and stability of the implant. Given the correct indication all surgical treatment can lead to satisfactory clinical and radiographic results despite a relevant complication rate. (www.actabiomedica.it)
Persistent pain management in orthopedics [La gestione del dolore persistente in ortopedia]
No full textPain secondary to degenerative osteoarticular pathologies is one of the main symptoms in orthopedics. Owing to the chronic pain, associated with functional limitation, patients turn to the orthopedist and decide to undergo knee or hip replacements. In most cases, the waiting period prior to operation is characterised by the moderate-severe pain which limits the patients' function and activity. Control of pain is also important postoperatively. In fact severe pain is associated with longer hospitalisation, poor compliance with the rehabilitation programme, a delay in starting to walk again or to an increase in postoperative complications. Among the conventional pain-killing treatments we would mention the non-steroid anti-inflammatory drugs and the opioids. Generally speaking the former should be administered for a maximum period of 15-20 days as they are poorly tolerated; the latter on the other hand can prove difficult to manage for the physician and unpopular with patients owing to their pharmacological interactions, the poor gastrointestinal tolerance and the dependence phenomenon. A new molecule (tapentadol) has recently been introduced in Italy. This possesses a particular action mechanism which differentiates it from all the analgesics thus far available to the point where a new therapeutic class, MOR-NRI, has been hypothesised. In orthopaedic clinical practice this can translate into the possibility of a more appropriate and effective analgesie therapy in patients with persistent pain, thus enabling the orthopedist to find a simple, correct approach in situations where other therapeutic options can prove complex or unsuitable
Inquadramento clinico diagnostico delle fratture periprotesiche
No full textThis paper critically reviews the literature on epidemiology, risk factors, clinical evaluation and diagnostic assessment of both femoral and acetabular periprosthetic fractures (PPF). Evaluation of both National Registries and the literature shows an increase in PPF rates throughout the years. The exact rate of PPF cases appears to be underestimated, especially as regards intraoperative and acetabular PPF. There are multiple risk factors for PPF, both patient-related and implant-related. In detail, bone mechanical resistance impairment and conditions of poor alignment, loosening and implant design should all be carefully considered. A thorough radiographic assessment together with evaluation of radiographic history of the implant are paramount to diagnose the fracture condition and possible loosening. CT scans are useful for diagnosing PFF in case of negative X-rays, especially on the acetabular side. The classification systems described in the literature proved to be reliable and reproducible, especially for the femur. Hip PPFs are a growing problem because of the increase in total hip arthroplasty implants and because of population ageing. Clinical evaluation and diagnostic assessment are of primary importance in the management of these fractures. The diagnosis needs to be properly addressed by clinical suspicion, with the use of second-level exams in selected cases
Humeral shaft aseptic non-union in elderly patients: treatment with opposite structural allograft, BMP-7 and mesenchymal stem cells
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