RESUMO
We present a case of a distant pedicled flap to reconstruct a defect at the distal upper extremity. We used this flap as a salvage procedure to treat a patient in the intensive care unit who was in a reduced general condition with numerous comorbidities that made regional or free microvascular flaps hazardous.
Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica/métodos , Terapia de Salvação/métodos , Lesões dos Tecidos Moles/cirurgia , Traumatismos do Punho/cirurgia , Idoso , Humanos , Masculino , Resultado do TratamentoRESUMO
AIM: The goal in treatment of metacarpal fractures is to restore the normal function of the hand. Although a majority of these fractures can be treated non-operatively, surgery is recommended for displaced fractures and in case of a patient wish for primary stability for practise. A poor clinical outcome is described for metacarpal shortening of more than 5 millimeters and for rotational deformity. Whereas plate osteosynthesis may lead to soft tissue irritation involving tendon adhesions and scar formation, we have used the elastic stable intramedullary nailing [ESIN] technique using titanium elastic nails (TEN) for intramedullary splinting of short metacarpal shaft and neck fractures. METHOD: Within 5 years, ESIN was performed in 95 patients. The operative technique was evaluated retrospectively concerning its functional results and complications. RESULTS: Sixty-three patients were analysed after an average follow-up of 14.0 ± 5.2 weeks. The mean DASH-Score was 2.3 ± 3.9 points. We saw one implant out-of-position and three cases of skin irritation affording TEN shortening. Two superficial wound infections were treated conservatively. Pseudarthrosis and nail breakage were not observed. After TEN removal 9 ± 2.4 weeks post implantationem no refracture occurred. CONCLUSION: Minimally invasive intramedullary stabilisation of short metacarpal shaft and neck fractures with a TEN is a safe surgical technique and achieves primary stability for practise. It reliably leads to fracture healing and produces excellent functional results.
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Titânio , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Módulo de Elasticidade , Análise de Falha de Equipamento , Feminino , Fixação Intramedular de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Ossos Metacarpais/diagnóstico por imagem , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Desenho de Prótese , Radiografia , Estudos Retrospectivos , Contenções , Resultado do Tratamento , Adulto JovemRESUMO
In contrast to the common intra- or extra-articular fractures of the distal radius, radiocarpal fracture dislocations are rare injuries. Concerning this issue, only a small number of publications can be found. Nevertheless, it is important to be informed about this injury since prompt operative treatment is often required and immobilization alone will not be sufficient. Sometimes, radiocarpal fracture dislocations are combined with carpal injuries. In such cases, both the radiocarpal dislocation and carpal injury have to be treated. Diagnostic difficulties can lead to misinterpretation or underdiagnosis. Insufficient reduction and fixation may result in joint incongruity and subsequent osteoarthritis. Reconstruction of the radiocarpal ligaments is a substantial part of operative treatment.