RESUMO
INTRODUCTION: We present a retrospective study on different treatment options for scaphoid nonunion. The results are compared to the literature and a treatment algorithm is proposed. MATERIALS AND METHODS: Based on a retrospective case-control study, 208 patients suffering from scaphoid nonunion were treated between 2000 and 2006. The patients were grouped depending on the localization of the nonunion: proximal (n=10), middle (n=105), or distal (n=93) third. In the presence of a small avascular proximal fragment, a vascularized bone graft from the distal radius was added (n=53). The determination of scaphoid healing was achieved by conventional radiographs or CT scans. RESULTS: Overall scaphoid healing occurred in 89.9% (n=187). For small proximal scaphoid fragments (n=93), we could show healing rates up to 83% (n=77). Using a vascularized bone graft from the distal radius, scaphoid consolidation was achieved in 81% for avascular proximal fragments and recurrent scaphoid nonunion (n=53). CONCLUSION: Using sophisticated treatment options, the prognosis of scaphoid nonunions is very good.
Assuntos
Algoritmos , Transplante Ósseo/estatística & dados numéricos , Ossos do Carpo/cirurgia , Fraturas Mal-Unidas/epidemiologia , Fraturas Mal-Unidas/cirurgia , Adulto , Estudos de Casos e Controles , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Prevalência , Resultado do TratamentoRESUMO
Polyneuropathy causing ulceration and amputation as a long-term consequence of diabetes mellitus is analysed for its pathophysiology, socioeconomic and medical relevance. Outcomes of decompression of peripheral nerves on the lower extremity regarding sensation, pain, development, and recurrence of ulceration, and amputation is evaluated by a systematic literature review in pubmed, medline and embase. Decompression of peripheral nerves in diabetic peripheral neuropathy seems to be a good treatment option for restoring sensation, decreasing pain, as well as for avoiding the development and recurrence of ulceration and amputation.
Assuntos
Descompressão Cirúrgica/métodos , Neuropatias Diabéticas/cirurgia , Nervos Periféricos/cirurgia , Neuropatias Diabéticas/diagnóstico , Humanos , Perna (Membro)/inervaçãoRESUMO
Today textured breast implants for augmentation and reconstruction are commonly used to reduce the incidence of capsular contractures. Despite modified surfaces, capsular contracture may occur as result of traumatic or iatrogenic ruptures of the implant along with discharge of filling material.We report the interesting case of a female patient with traumatic rupture of one prosthesis in an industrial accident 14 years after implantation of hydrogel-filled breast prostheses. As it was a work related accident, the Employer's Liability Insurance Association is responsible for covering the treatment. The patient history and the histological exam have proven that the accident was work related.
Assuntos
Acidentes de Trabalho/legislação & jurisprudência , Implantes de Mama , Mama/lesões , Prova Pericial/legislação & jurisprudência , Hidrogel de Polietilenoglicol-Dimetacrilato , Falha de Prótese , Indenização aos Trabalhadores/legislação & jurisprudência , Feminino , Humanos , Pessoa de Meia-Idade , RupturaRESUMO
The surgical treatment of peripheral nerve injuries is still a challenging and highly demanding procedure. Past results have been improved upon by different advances in microsurgical techniques and algorithms. Nevertheless, results are not always satisfying, making secondary procedures necessary. Thus, these secondary procedures such as tendon transfers and arthrodesis of different joints must be taken into account during reconstructive planning. This review gives an overview of peripheral nerve reconstruction (nerve grafting, nerve repair) and the pertinent secondary procedures.