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1.
Sports Med Arthrosc Rev ; 32(2): 104-112, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38978204

RESUMO

Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.


Assuntos
Artroscopia , Traumatismos em Atletas , Cartilagem Articular , Traumatismos da Mão , Traumatismos do Punho , Humanos , Traumatismos do Punho/terapia , Traumatismos do Punho/cirurgia , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/diagnóstico por imagem , Traumatismos em Atletas/terapia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/cirurgia , Traumatismos da Mão/terapia , Traumatismos da Mão/cirurgia , Traumatismos da Mão/diagnóstico , Artroscopia/métodos , Cartilagem Articular/lesões , Cartilagem Articular/cirurgia , Volta ao Esporte , Exame Físico
2.
JAAPA ; 37(6): 31-33, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38985112

RESUMO

ABSTRACT: This case report describes a 45-year-old man whose left hand was skewered by a catfish spine while he was attempting to dehook the fish. Catfish spines can create punctures, lacerations, and foreign body injuries. The catfish spine generally is serrated, which can make removal difficult.


Assuntos
Peixes-Gato , Corpos Estranhos , Traumatismos da Mão , Linfangite , Humanos , Masculino , Pessoa de Meia-Idade , Animais , Corpos Estranhos/complicações , Traumatismos da Mão/etiologia , Linfangite/etiologia , Linfangite/diagnóstico
3.
Syst Rev ; 13(1): 157, 2024 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-38877569

RESUMO

BACKGROUND: The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery. METHODS AND ANALYSIS: The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta-Analysis (CINEMA). DISCUSSION: This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023429618.


Assuntos
Antibacterianos , Antibioticoprofilaxia , Traumatismos da Mão , Metanálise em Rede , Infecção da Ferida Cirúrgica , Revisões Sistemáticas como Assunto , Humanos , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia/métodos , Traumatismos da Mão/cirurgia , Antibacterianos/uso terapêutico , Projetos de Pesquisa , Cirurgia de Cuidados Críticos
4.
Mymensingh Med J ; 33(3): 772-776, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38944720

RESUMO

Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.


Assuntos
Traumatismos da Mão , Retalho Perfurante , Lesões dos Tecidos Moles , Humanos , Retalho Perfurante/transplante , Masculino , Lesões dos Tecidos Moles/cirurgia , Feminino , Adulto , Estudos Prospectivos , Traumatismos da Mão/cirurgia , Pessoa de Meia-Idade , Antebraço/cirurgia , Adolescente , Traumatismos do Antebraço/cirurgia , Adulto Jovem , Procedimentos de Cirurgia Plástica/métodos , Criança
5.
Adv Skin Wound Care ; 37(7): 387-391, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38899821

RESUMO

ABSTRACT: Intravenous plasminogen replacement therapy for patients with plasminogen deficiency type 1 (hypoplasminogenemia) was recently approved for marketing in the US. In this case report, the authors describe a 33-year-old man with hypoplasminogenemia who developed nonhealing postsurgical wounds following trauma to his right hand despite receiving standard treatment for 4 months. The patient was enrolled in a compassionate-use protocol with intravenous plasminogen replacement therapy and experienced prompt resolution of surgical wounds. He was the first human patient to receive replacement therapy with plasminogen, human-tvmh in the US and first to demonstrate cutaneous wound healing in addition to resolution of ligneous lesions attributable to plasminogen deficiency type 1.


Assuntos
Plasminogênio , Cicatrização , Humanos , Masculino , Adulto , Cicatrização/efeitos dos fármacos , Plasminogênio/deficiência , Plasminogênio/uso terapêutico , Administração Intravenosa , Resultado do Tratamento , Traumatismos da Mão/complicações , Traumatismos da Mão/cirurgia , Ferida Cirúrgica/tratamento farmacológico , Ferida Cirúrgica/complicações , Conjuntivite , Dermatopatias Genéticas
6.
Clin Plast Surg ; 51(3): 365-377, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38789146

RESUMO

The hand is commonly affected in thermal injuries. Hand burns account for 39% of all burns and they are involved in 34% of instances when the total body surface area of a burn exceeds 15%. Inadequate or inappropriate treatment could result in significant morbidity. The ultimate integration of a burn patient into the society largely depends on the functionality of the hands. Hence, it is important to reduce complications by providing good care during the acute stage.


Assuntos
Queimaduras , Traumatismos da Mão , Procedimentos de Cirurgia Plástica , Humanos , Queimaduras/cirurgia , Queimaduras/terapia , Traumatismos da Mão/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos
8.
Int Wound J ; 21(5): e14934, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38783559

RESUMO

Preservation and restoration of hand function after burn injuries are challenging yet imperative. This study aimed to assess the curative effect of a composite skin graft over an acellular dermal matrix (ADM) and a thick split-thickness skin graft (STSG) for treating deep burns on the hand. Patients who met the inclusion criteria at the First Affiliated Hospital of Wenzhou Medical University between September 2011 and January 2020 were retrospectively identified from the operative register. We investigated patient characteristics, time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery, donor site recovery, complications and days to complete healing. Patients were followed up for 12 months to evaluate scar quality using the Vancouver Scar Scale (VSS) and hand function through total active motion (TAM) and the Jebsen-Taylor Hand Function Test (JTHFT). A total of 38 patients (52 hands) who received thin STSG on top of the ADM or thick STSG were included. The location of the donor sites was significantly different between Group A (thick STSG) and Group B (thin STSG + ADM) (p = 0.03). There were no statistical differences in age, gender, underlying disease, cause of burn, burn area, dominant hand, patients with two hands operated on and time from burn to surgery between the two groups (p > 0.05). The time from operation to the start of active motion exercise, take rates of skin graft 7 days post-surgery and days to complete healing were not significantly different between Group A and Group B (p > 0.05). The rate of donor sites requiring skin grafting was lower in Group B than in Group A (22.2% vs. 100%, p < 0.001). There were no statistically significant differences in complications between the groups (p = 0.12). Moreover, 12 months postoperatively, the pliability subscore in the VSS was significantly lower in Group A than in Group B (p = 0.01). However, there were no statistically significant differences in vascularity (p = 0.42), pigmentation (p = 0.31) and height subscores (p = 0.13). The TAM and JTHFT results revealed no statistically significant differences between the two groups (p = 0.22 and 0.06, respectively). The ADM combined with thin STSG is a valuable approach for treating deep and extensive hand burns with low donor site morbidity. It has a good appearance and function in patients with hand burns, especially in patients with limited donor sites.


Assuntos
Derme Acelular , Queimaduras , Traumatismos da Mão , Transplante de Pele , Humanos , Queimaduras/cirurgia , Masculino , Feminino , Transplante de Pele/métodos , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Traumatismos da Mão/cirurgia , Adulto Jovem , Cicatrização/fisiologia , Cicatriz , Resultado do Tratamento
9.
Georgian Med News ; (348): 40-43, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38807388

RESUMO

Complex comminuted hand injuries are an urgent medical and social problem of national health systems, which is especially sensitive for countries with a low level of socio-economic development. The work aims to substantiate the effectiveness and safety of the shoelace method of hand bone osteosynthesis in complex comminuted fractures (a clinical case study). Clinical case: A 42-year-old female patient was admitted to the clinic with complaints of the presence of a crushed wound on the 2nd finger of the left hand. The shoelace method was applied for hand bone osteosynthesis. The surgical intervention time was 24 minutes, and the time before returning to work or daily activities equaled 7.1 weeks. The time to bone fusion was less than 45 days. The shoelace osteosynthesis method in complex comminuted fractures of the hand bones has prospects for modern clinical practice with the possibility of improving the performance and safety indicators.


Assuntos
Fixação Interna de Fraturas , Fraturas Cominutivas , Humanos , Feminino , Adulto , Fraturas Cominutivas/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Traumatismos da Mão/cirurgia , Ossos da Mão/cirurgia , Ossos da Mão/lesões , Ossos da Mão/diagnóstico por imagem
10.
Eur Rev Med Pharmacol Sci ; 28(6): 2317-2321, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38567594

RESUMO

OBJECTIVE: Metacarpal fractures are one of the most common orthopedic injuries seen in emergency departments. Despite this, only a few data have been published about the epidemiology of metacarpal fractures. Simple radiographs are the standard imaging modality used to diagnose boxer fractures and determine the degree of angulation. Fractures and angulations should be identified by anteroposterior and lateral radiographs. The aim of this study was to follow the healing after closed reduction of fifth metacarpal neck fractures in a pediatric population using the QuickDASH score to determine whether it results in clinically significant improvement. SUBJECTS AND METHODS: Between 2020 and 2022, our clinical record database for all metacarpal fractures treated at our institution was searched retrospectively every month. Children aged 18 years and younger with fifth metacarpal neck fractures treated with closed reduction and immobilization in our tertiary care emergency clinic were retrospectively reviewed. RESULTS: 52 pediatric patients were included in the study. The mean age at the time of injury was 14.04 years (SD=2.10, range=10-18 years). 92.30% (n=48) of the patients were male, and 7.70% (n=4) were female. CONCLUSIONS: Accurate diagnosis and appropriate treatment are crucial in the management of childhood fifth metacarpal fractures to ensure proper healing, prevent long-term complications, and facilitate optimal functional recovery.


Assuntos
Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Humanos , Masculino , Feminino , Criança , Adolescente , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/lesões , Estudos Retrospectivos , Resultado do Tratamento , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Consolidação da Fratura , Traumatismos da Mão/terapia
11.
Artigo em Chinês | MEDLINE | ID: mdl-38664031

RESUMO

Objective: To explore the clinical effects of early rehabilitation treatment after repair surgery of skin and soft tissue defects accompanied by extensor tendon injury on the back of hand. Methods: This study was a retrospective non-randomized controlled study. From February 2015 to February 2023, 24 patients (15 males and 9 females, aged 12-55 years) with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand, who met the inclusion criteria and were repaired with flap transplantation and tendon grafting or tendon anastomosis, were admitted to the First Affiliated Hospital of Air Force Medical University. According to different intervention time for postoperative rehabilitation treatment of patients, the patients were divided into conventional rehabilitation group and early rehabilitation group, with 12 cases in each group. Patients in early rehabilitation group received rehabilitation treatment immediately after surgery under the rehabilitation guidance of specialized rehabilitation physicians based on the characteristics of different postoperative periods. Patients in conventional rehabilitation group began rehabilitation treatment from the third week after surgery, and their rehabilitation treatment was the same as that of patients in early rehabilitation group from the second week after surgery. The patients in 2 groups were treated in the hospital until the sixth week after surgery. The occurrence of flap vascular crisis and tendon rupture were observed within 6 weeks after surgery. After 6 weeks of surgery, the manual muscle test was used to measure the pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, and grip force of the affected hand; the total action motion method was used to evaluate the finger joint range of motion of the affected hand, and the excellent and good ratio was calculated; the Carroll upper extremity function test was used to score and rate the function of the affected hand. Results: Within 6 weeks after surgery, only 1 patient in conventional rehabilitation group suffered from venous crisis, and the flap survived after the second surgical exploration and anastomosis of blood vessels; there was no occurrence of tendon rupture in patients of 2 groups. After 6 weeks of surgery, there were no statistically significant differences in pinching force between the index finger and thumb, lateral pinching force, three-point pinching force, or grip force of the affected hand between the two groups of patients (P>0.05); the excellent and good ratio of the finger joint range of motion of the affected hand of patients in early rehabilitation group was 11/12, which was higher than 7/12 in conventional rehabilitation group, but there was no statistically significant difference (P>0.05); the affected hand function score of patients in early rehabilitation group was 90±6, which was significantly higher than 83±8 in conventional rehabilitation group (t=2.41, P<0.05); the function rating of the affected hand of patients in early rehabilitation group was obviously better than that in conventional rehabilitation group (Z=2.04, P<0.05). Conclusions: Early rehabilitation treatment for patients with skin and soft tissue defects accompanied by extensor tendon injury on the back of hand after repair surgery can improve hand function, but it would not increase surgery related complications, which is worthy of clinical promotion and application.


Assuntos
Lesões dos Tecidos Moles , Retalhos Cirúrgicos , Traumatismos dos Tendões , Humanos , Masculino , Feminino , Adulto , Estudos Retrospectivos , Traumatismos dos Tendões/reabilitação , Traumatismos dos Tendões/cirurgia , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/cirurgia , Lesões dos Tecidos Moles/reabilitação , Retalhos Cirúrgicos/cirurgia , Adolescente , Traumatismos da Mão/cirurgia , Traumatismos da Mão/reabilitação , Adulto Jovem , Mãos/cirurgia , Criança , Pele/lesões , Tendões/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos
12.
BMC Musculoskelet Disord ; 25(1): 270, 2024 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-38589862

RESUMO

BACKGROUND: Fractures of hands and feet are common in children, but relevant epidemiological studies are currently lacking. We aim to study the epidemiological characteristics of hand and foot fractures and growth plate injuries in children and provide a theoretical basis for their prevention, diagnosis, and treatment. METHODS: We retrospectively analyzed the data of children with hand and foot fractures who were hospitalized at Shenzhen Children's Hospital between July 2015 and December 2020. Data on demographic characteristics, fracture site, treatment method, etiology of injury, and accompanying injuries were collected. The children were divided into four age groups: infants, preschool children, school children, and adolescents. The fracture sites were classified as first-level (the first-fifth finger/toe, metacarpal, metatarsal, carpal, and tarsal) and second-level (the first-fifth: proximal phalanx, middle phalanx, distal phalanx, metacarpal, and metatarsal) sites. The changing trends in fracture locations and injury causes among children in each age group were analyzed. RESULTS: Overall, 1301 children (1561 fractures; 835 boys and 466 girls) were included. The largest number of fractures occurred in preschool children (n = 549, 42.20%), with the distal phalanx of the third finger being the most common site (n = 73, 15.57%). The number of fractures in adolescents was the lowest (n = 158, 12.14%), and the most common fracture site was the proximal phalanx of the fifth finger (n = 45, 29.61%). Of the 1561 fractures, 1143 occurred in the hands and 418 in the feet. The most and least common first-level fracture sites among hand fractures were the fifth (n = 300, 26.25%) and first (n = 138, 12.07%) fingers, respectively. The most and least common first-level foot fracture locations were the first (n = 83, 19.86%) and fourth (n = 26, 6.22%) toes, respectively. The most common first-level and second level etiologies were life related injuries (n = 1128, 86.70%) and clipping injuries (n = 428, 32.90%), respectively. The incidence of sports injuries gradually increased with age, accounting for the highest proportion in adolescents (26.58%). Hand and foot fractures had many accompanying injuries, with the top three being nail bed injuries (570 cases, 36.52%), growth plate injuries (296 cases, 18.96%), and distal severed fracture (167 cases, 10.70%). Among the 296 growth plate injuries, 246 occurred on the hands and 50 on the feet. CONCLUSIONS: In contrast to previous epidemiological studies on pediatric hand and foot fractures, we mapped the locations of these fractures, including proximal, shaft, distal, and epiphyseal plate injuries. We analyzed the changing trends in fracture sites and injury etiologies with age. Hand and foot fractures have many accompanying injuries that require attention during diagnosis and treatment. Doctors should formulate accident protection measures for children of different ages, strengthen safety education, and reduce the occurrence of accidental injuries.


Assuntos
Traumatismos do Pé , Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Fraturas Salter-Harris , Masculino , Pré-Escolar , Lactente , Feminino , Adolescente , Criança , Humanos , Estudos Retrospectivos , Fraturas Salter-Harris/complicações , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Fraturas Ósseas/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/etiologia , Traumatismos da Mão/terapia , Ossos Metacarpais/lesões , Traumatismos do Pé/epidemiologia , Traumatismos do Pé/etiologia , Traumatismos do Pé/terapia
13.
Hand Surg Rehabil ; 43(2): 101678, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428635

RESUMO

BACKGROUND: The need for prophylactic antibiotic treatment of hand wounds in children requiring emergency surgical exploration is still controversial. Our starting hypothesis was that the absence of prophylactic antibiotic treatment in this setting (as specified by a decision tree) does not increase the likelihood of surgical site infection. METHODS: A decision tree for antibiotic prescription was developed by a working group in compliance with the guidelines issued by the French High Authority for Health, as part of a clinical pathway. One injection of intravenous antibiotics was prescribed for bite injuries, open joint injuries, injuries left untreated for more than 24 h, and suspected contaminated wounds. All children admitted for surgical treatment of a hand wound between July 2018 and March 2023 were included. Demographic data, antibiotic prescription and onset of postoperative surgical site infection were recorded. RESULTS: The 238 children included had a mean age of 8 ± 4.8 years; 102 received antibiotics and 136 did not. Eleven children (4.6%) had superficial surgical site infection requiring no revision surgery or antibiotic therapy. 206 children (86.5%) were treated following the decision tree. Ten had superficial surgical site infection: 3 received antibiotics (3.7% of the 80 who were treated) and 7 did not (5.5% of the 126 not treated) (p = 0.74). Thirty-two patients (13.5%) were off-protocol, only 1 of whom received antibiotics for superficial surgical site infection. DISCUSSION: Applying the decision tree standardized the prescription of antibiotics in hand wounds, was not associated with a significantly greater rate of surgical site infection, and avoided exposure to antibiotics for 61.1% of the children, thus limiting potential adverse events. LEVEL OF EVIDENCE: III.


Assuntos
Antibacterianos , Antibioticoprofilaxia , Árvores de Decisões , Traumatismos da Mão , Infecção da Ferida Cirúrgica , Humanos , Criança , Traumatismos da Mão/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Masculino , Feminino , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Pré-Escolar , Adolescente
14.
Arch Orthop Trauma Surg ; 144(5): 2443-2447, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38546860

RESUMO

INTRODUCTION: Patients and physicians often underestimate cat bite injuries. The deep and narrow wound seals quickly and provides an environment for the inoculated saliva and bacteria. Interestingly, the literature reports no bacterial growth in the microbiological workup of wound swaps in up to 43%. The time between bite injury and the first clinical presentation, the start of antibiotic treatment and surgical debridement might affect these findings. Therefore, the current project examines if (1) these factors impact the outcome of microbiological results following cat bite injuries and (2) the detection of bacterial growth leads to higher complication rates, longer hospital stays, longer total treatment time, or higher total treatment costs. MATERIALS AND METHODS: This single-center retrospective study analyzed data from 102 adult patients. All patients received antibiotic and surgical treatment following a cat bite injury. Microbiological samples were collected during surgery in all cases. The time from the bite incident to the first presentation, beginning of antibiotic administration, and surgical debridement was calculated. Demographic data, complication rate, length of hospital stay, total treatment time, and total treatment costs were recorded. (1) A generalized linear model was fitted using the microbiological outcome as the dependent variable. (2) Two groups (negative or positive microbiological results) were formed and statistically compared. RESULTS: The median age was 50 (SD 16), and 72% were female. (1) The time from the bite incident to the first clinical presentation, antibiotic administration, or surgical treatment was not associated with the outcome of the microbiological result. (2) No significant differences were observed between the two groups. CONCLUSIONS: Our data do not suggest that early antibiotic administration or delayed surgical treatment affects the outcome of the microbiological workup following cat bite injuries to the hand and forearm. The microbiological outcome did not affect the complication rate, treatment time, and total treatment costs.


Assuntos
Antibacterianos , Mordeduras e Picadas , Traumatismos da Mão , Mordeduras e Picadas/complicações , Mordeduras e Picadas/microbiologia , Mordeduras e Picadas/cirurgia , Feminino , Animais , Humanos , Masculino , Gatos , Estudos Retrospectivos , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Adulto , Traumatismos da Mão/cirurgia , Traumatismos da Mão/microbiologia , Desbridamento , Traumatismos do Antebraço/cirurgia , Resultado do Tratamento , Idoso , Tempo de Internação/estatística & dados numéricos
15.
Hand Surg Rehabil ; 43(2): 101679, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38428636

RESUMO

OBJECTIVES: To explore the clinical application and efficacy of transplantation of free composite flaps supplied by radial osteocutaneous branch of the dorsal branch of the anterior interosseous artery for reconstructing bone and skin defects in the hand. MATERIAL AND METHODS: Anatomically, the radial osteocutaneous branch of the dorsal branch of the anterior interosseous artery has constant collateral anastomoses which can provide a large dorsoradial flap from the dorsum of the forearm. This flap was used for reconstruction in five cases of cutaneous and phalangeal defects. RESULTS: Reconstruction was successful in all five cases, with consolidated phalanx and good cosmetic results. All donor sites could be closed directly. CONCLUSION: Reconstruction with dorsoradial forearm flaps is a reliable procedure which causes minimal trauma. Thus, it is an ideal approach for repairing cutaneous and phalangeal defects.


Assuntos
Retalhos de Tecido Biológico , Humanos , Antebraço/cirurgia , Antebraço/irrigação sanguínea , Retalhos de Tecido Biológico/irrigação sanguínea , Traumatismos da Mão/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Artéria Radial/transplante
16.
Bone Joint J ; 106-B(4): 387-393, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38555933

RESUMO

Aims: There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. Methods: This multicentre cohort study at eight centres in the UK included all patients with an acute scaphoid fracture diagnosed on MRI having presented acutely following wrist trauma with normal radiographs. Data were gathered retrospectively for a minimum of 12 months at each centre. The primary outcome measures were the rate of acute surgery, delayed union, and nonunion. Results: A total of 1,989 patients underwent acute MRI for a suspected scaphoid fracture during the study period, of which 256 patients (12.9%) were diagnosed with a previously occult scaphoid fracture. Of the patients with scaphoid fractures, six underwent early surgical fixation (2.3%) and there was a total of 16 cases of delayed or nonunion (6.3%) in the remaining 250 patients treated with cast immobilization. Of the nine nonunions (3.5%), seven underwent surgery (2.7%), one opted for non-surgical treatment, and one failed to attend follow-up. Of the seven delayed unions (2.7%), one (0.4%) was treated with surgery at two months, one (0.4%) did not attend further follow-up, and the remaining five fractures (1.9%) healed after further cast immobilization. All fractures treated with surgery had united at follow-up. There was one complication of surgery (prominent screw requiring removal). Conclusion: MRI-detected scaphoid fractures are not universally benign, with delayed or nonunion of scaphoid fractures diagnosed only after MRI seen in over 6% despite appropriate initial immobilization, with most of these patients with nonunion requiring surgery to achieve union. This study adds weight to the evidence base supporting the use of early MRI for these patients.


Assuntos
Fraturas Ósseas , Fraturas Fechadas , Fraturas não Consolidadas , Traumatismos da Mão , Osso Escafoide , Traumatismos do Punho , Humanos , Fraturas Ósseas/cirurgia , Estudos Retrospectivos , Estudos de Coortes , Osso Escafoide/lesões , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fraturas Fechadas/diagnóstico por imagem , Fraturas Fechadas/etiologia , Imageamento por Ressonância Magnética , Traumatismos da Mão/complicações , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/cirurgia , Fraturas não Consolidadas/complicações
17.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484095

RESUMO

CASE: A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large osseous defect of the right thumb metacarpal. The patient was successfully treated with metacarpophalangeal joint arthrodesis and metacarpal reconstruction using definitive external fixation, an intramedullary Kirschner wire, and use of the Masquelet bone grafting technique. CONCLUSION: The authors' treatment approach for a mangled thumb injury with definitive external fixation and utilization of the Masquelet technique resulted in restoration of a large osseous defect, avoidance of infection, and limited loss of mobility.


Assuntos
Traumatismos da Mão , Procedimentos de Cirurgia Plástica , Ferimentos por Arma de Fogo , Humanos , Masculino , Adulto Jovem , Fixadores Externos , Fixação de Fratura/métodos , Traumatismos da Mão/cirurgia , Polegar/cirurgia , Ferimentos por Arma de Fogo/cirurgia
18.
J Hand Surg Asian Pac Vol ; 29(2): 134-139, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38494164

RESUMO

Background: The most common types of wrist dislocation are trans-scaphoid lunate dislocation (TLD) and trans-scaphoid perilunate dislocation, in which the lunate and proximal scaphoid are dislocated through the midcarpal joint. There is another rare type of dislocation in which the proximal carpi are dislocated through the radiocarpal joint. The purpose of this study is to examine the clinical features of this type of dislocation. Methods: Six cases of the proximal carpal fracture dislocation via the radiocarpal joint were retrospectively reviewed. All patients underwent open reduction and internal fixation with the ligament reconstruction. A Mayo wrist score was assigned to each patient based on the assessment of pain, functional status, range of motion and grip strength at the last follow-up. Clinical subjective evaluation of function and pain was assessed using the patient-rated wrist evaluation (PRWE) method. Results: All patients were male and injured with a median age of 33.5 years. The median follow-up period was 10 months. There were three types of dislocations: Scaphoid fracture dislocation, TLD and scaphoid-lunate dislocation. All patients had satisfactory results with an average PRWE of 7.2 ± 4.7. The preoperative VAS was 6.7 ± 1.0 and the postoperative VAS was 0.7 ± 0.7 (p < 0.01). Postoperative grip strength accounted for 89.2% ± 9.8% of the contralateral side; the Mayo wrist score averaged 90.0 ± 6.5, with four patients obtaining excellent and two good results. Conclusions: Fracture dislocation of the proximal carpal bones through the radiocarpal joint is an independent type of wrist dislocation that tends to occur in young men with high-energy impact. The wrist is most often injured in a pronation hyperextension position. If treatment is timely and appropriate, the prognosis is quite good. Level of Evidence: Level IV (Therapeutic).


Assuntos
Fratura-Luxação , Fraturas Ósseas , Traumatismos da Mão , Luxações Articulares , Osso Escafoide , Traumatismos do Punho , Humanos , Masculino , Adulto , Feminino , Fraturas Ósseas/cirurgia , Estudos Retrospectivos , Osso Escafoide/cirurgia , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia
19.
Br J Sports Med ; 58(11): 606-614, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38508702

RESUMO

OBJECTIVE: To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency. DESIGN: Systematic epidemiological review and meta-analysis. DATA SOURCES: PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023. ELIGIBILITY CRITERIA: Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites. RESULTS: 20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week. CONCLUSION: Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies. PROSPERO REGISTRATION NUMBER: CRD42023408738.


Assuntos
Traumatismos em Atletas , Golfe , Humanos , Traumatismos em Atletas/epidemiologia , Lesões nas Costas/epidemiologia , Golfe/lesões , Traumatismos da Mão/epidemiologia , Incidência , Sistema Musculoesquelético/lesões , Prevalência , Fatores de Risco , Lesões dos Tecidos Moles/epidemiologia , Traumatismos do Punho/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade
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