RESUMO
BACKGROUND: Skiing and snowboarding are popular sports that are associated with a high number of orthopaedic injuries. Diaphyseal forearm fractures are an important subset of these injuries. To our knowledge, factors associated with these injuries, the mechanisms that cause them, and their relative frequencies in skiers and snowboarders have not been described. In addition, it has been proposed that the use of wrist guards may increase the risk of sustaining a diaphyseal forearm fracture; therefore, we sought to explore the relationship between wrist guard use and diaphyseal forearm fractures. QUESTIONS/PURPOSES: (1) What are the relative frequencies and types of diaphyseal forearm fractures in skiers and snowboarders? (2) What factors are associated with these injuries? (3) Is the use of wrist guards associated with an increased risk of forearm fractures? METHODS: This was an unmatched case-control study performed with an injury database from a university-run clinic at the base lodge of a major ski resort. Cases were injured skiers and snowboarders; controls were randomly selected uninjured skiers and snowboarders. Data were collected on the mechanism of injury; experience level; equipment; radiographs; skiing or snowboarding habits; and trail type, defined as green circle (easiest), blue square (intermediate), black diamond (difficult), and double black diamond (most difficult). From this database, we identified 84 patients with diaphyseal forearm fractures, one of which was a Monteggia fracture and was excluded. A logistic regression analysis was used to compare the injured and control groups to identify factors associated with diaphyseal forearm fractures, including wrist guard use. RESULTS: When adjusted for participant days, diaphyseal forearm fractures were more common in snowboarders than skiers (0.03 injuries per 1000 person-days versus 0.004 per 1000 person-days). On multivariable analysis, factors associated with forearm fractures in skiers were younger age (odds ratio 1.08 [95% CI 1.05 to 1.14]; p < 0.01), being a man or boy (OR 11.9 [95% CI 2.5 to 57.2]; p < 0.01), lack of movement at the time of falling (OR 18.2 [95% CI 3.2 to 102.5]; p < 0.01), and skiing on green circle trails compared with black diamond trails (OR 3.6 [95% CI 1.4 to 12.5]; p = 0.04). Factors associated with forearm fractures in snowboarders were younger age (OR 1.08 [95% CI 1.02 to 1.15]; p = 0.01), decreased weight (OR 1.02 [95% CI 1.00 to 1.02]; p < 0.01), snowboarding on gentle terrain (OR 8.4 [95% CI 1.6 to 45.0]; p = 0.01), and snowboarding on groomed terrain compared with other (OR 7.2 [95% CI 1.9 to 28.0]; p < 0.01) or wet, heavy snow (OR 24.8 [95% CI 2.5 to 246.7]; p = 0.01). Wrist guard use was not associated with an increased odds of diaphyseal forearm fracture in skiers or snowboarders. CONCLUSION: Diaphyseal forearm fractures occur more frequently in snowboarders than in skiers. Despite speculation in prior evidence that wrist guards may paradoxically increase the risk of sustaining these injuries, our study suggests that this is not the case and wrist guards are not unsafe to wear. LEVEL OF EVIDENCE: Level III, prognostic study.
Assuntos
Traumatismos em Atletas/epidemiologia , Traumatismos do Antebraço/epidemiologia , Fraturas Ósseas/epidemiologia , Esqui/lesões , Adolescente , Adulto , Estudos de Casos e Controles , Criança , Diáfises , Feminino , Humanos , Masculino , Equipamento de Proteção Individual , Roupa de Proteção , Fatores de Risco , Vermont/epidemiologia , Adulto JovemRESUMO
PURPOSE: To determine and compare the incidence and severity of wrist fractures in skiers and snowboarders. METHODS: A university-run orthopedic clinic at the base of a major ski resort has maintained an injury database spanning the years 1972 to 2012. Demographic information, equipment type, ability level, trail type and conditions, number of falls, circumstances surrounding the injury, and radiographs were collected on participants sustaining wrist fractures and compared with uninjured control participants asked the same questions, but in reference to their last fall where no injury resulted. A risk factor model for wrist fracture and severity in alpine sports was developed. RESULTS: During the 40-year period, 679 wrist fractures were identified. The incidence of wrist fracture per 1,000 days was 0.447 in snowboarders and 0.024 in skiers. In comparison with a representative sample of uninjured skiers, bivariate analyses revealed that skiers who experienced fractures were less experienced, had a greater number of falls, were on green or double black trails, and were injured owing to jumping or other reason related to technique. A higher risk for fracture was found for beginners, males younger than age 16, women older than age 50, and 4 or fewer days skiing that season. Bivariate analyses found that injured snowboarders were more likely to be female, younger, less experienced and had received less instruction than uninjured snowboarders. Higher risk for wrist fracture among snowboarders was found to be associated with age younger than 18 and less experience. CONCLUSIONS: Wrist fractures occur at an 18 times greater incidence in snowboarders than in skiers. Skiers with wrist fractures were beginners, males younger than 16, women older than 50, or those who had less participation. Snowboarders sustaining wrist fractures were younger than 18 or had less experience. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.
Assuntos
Traumatismos em Atletas , Esqui , Adolescente , Traumatismos em Atletas/epidemiologia , Feminino , Humanos , Incidência , Masculino , Fatores de Risco , Estações do Ano , PunhoRESUMO
BACKGROUND AND AIMS: Intravenous regional anesthesia (IVRA) is utilized for upper extremity surgery, but higher tourniquet pressure and longer inflation time increase the risk of soft tissue and nerve injury. We investigated the duration and magnitude of elevated venous pressure during IVRA to assess the possibility of safely lowering the tourniquet pressure during surgery. MATERIAL AND METHODS: Twenty adult patients scheduled for distal upper extremity surgery were enrolled. An additional intravenous catheter was placed in the surgical arm connected to a digital pressure transducer for monitoring venous pressure. Venous pressure was recorded prior to IVRA and every 30 s after injection of local anesthetic (LA) until the completion of surgery. RESULTS: All 20 subjects completed the study without complication. Peak venous pressure was 340 mmHg in one patient which lasted for less than 30 s. Mean venous pressures fell below systolic blood pressure after 4.5 min in all cases except one. This patient had elevated venous pressures for 24 of 25 min of tourniquet time exceeding systolic blood pressure. The only statistically significant intraoperative factor associated with elevated venous pressure was elevated peak systolic pressure (P = 0.001). CONCLUSIONS: We found that the mean peak venous pressure was below systolic blood pressure in only 14 of the 20 subjects, and the peak injection pressure exceeded 300 mmHg in one patient. Another patient's venous pressure remained above systolic blood pressure for 24 of 25 min of tourniquet time. Current precautions to prevent LA toxicity may be insufficient in some patients and attempts to lower tourniquet pressures to just above systolic blood pressures soon after IVRA injection may result in toxicity, specifically if systolic pressure is elevated.
RESUMO
Acute and chronic infections and inflammation adjacent to the fingernail, or paronychia, are common. Paronychia typically develops following a breakdown in the barrier between the nail plate and the adjacent nail fold and is often caused by bacterial or fungal pathogens; however, noninfectious etiologies, such as chemical irritants, excessive moisture, systemic conditions, and medications, can cause nail changes. Abscesses associated with acute infections may spontaneously decompress or may require drainage and local wound care along with a short course of appropriate antibiotics. Chronic infections have a multifactorial etiology and can lead to nail changes, including thickening, ridging, and discoloration. Large, prospective studies are needed to identify the best treatment regimen for acute and chronic paronychia.
Assuntos
Antibacterianos/uso terapêutico , Paroniquia/diagnóstico , Paroniquia/terapia , Doença Aguda , Antifúngicos/uso terapêutico , Doença Crônica , Diagnóstico Diferencial , Drenagem , Humanos , Ilustração Médica , Paroniquia/etiologia , Fatores de RiscoRESUMO
In growing numbers, patients are using social media platforms as resources to obtain health information and report their experiences in the health care setting. More physicians are making use of these platforms as a means to reach prospective and existing patients, to share information with each other, and to educate the public. In this ever-expanding online dialogue, questions have arisen regarding appropriate conduct of the physician during these interactions. The purpose of this article is to review the laws that govern online communication as they pertain to physician presence in this forum and to discuss appropriate ethical and professional behavior in this setting.
Assuntos
Mãos/cirurgia , Ortopedia/ética , Mídias Sociais/ética , Mídias Sociais/normas , American Recovery and Reinvestment Act , Blogging , Comunicação , Confidencialidade , Correio Eletrônico , Guias como Assunto , Health Insurance Portability and Accountability Act , Humanos , Relações Médico-Paciente , Médicos/normas , Mídias Sociais/legislação & jurisprudência , Sociedades Médicas/legislação & jurisprudência , Estados UnidosAssuntos
Traumatismos do Braço/cirurgia , Hemostáticos/uso terapêutico , Procedimentos Ortopédicos/efeitos adversos , Hemorragia Pós-Operatória/tratamento farmacológico , Administração Tópica , Traumatismos do Braço/diagnóstico , Celulose Oxidada/uso terapêutico , Ensaios Clínicos Fase III como Assunto , Feminino , Seguimentos , Esponja de Gelatina Absorvível/uso terapêutico , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Hemorragia Pós-Operatória/diagnóstico , Índice de Gravidade de Doença , Trombina/uso terapêutico , Resultado do TratamentoAssuntos
Extremidade Inferior/fisiopatologia , Debilidade Muscular/fisiopatologia , Miastenia Gravis/fisiopatologia , Miastenia Gravis/terapia , Adulto , Progressão da Doença , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/terapia , Plasmaferese , Prognóstico , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Timectomia/métodos , Resultado do TratamentoAssuntos
Traumatismos da Mão/terapia , Tratamento de Ferimentos com Pressão Negativa , Animais , Terapia Combinada , Desbridamento , Desenho de Equipamento , Traumatismos dos Dedos/cirurgia , Traumatismos dos Dedos/terapia , Traumatismos da Mão/cirurgia , Humanos , Tratamento de Ferimentos com Pressão Negativa/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Transplante de PeleAssuntos
Cotos de Amputação , Traumatismos da Mão/cirurgia , Procedimentos Ortopédicos/métodos , Amputados/reabilitação , Cegueira/epidemiologia , Comorbidade , Epônimos , Estética , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/reabilitação , Humanos , Procedimentos Ortopédicos/reabilitação , Seleção de PacientesAssuntos
Antineoplásicos/efeitos adversos , Toxidermias/diagnóstico , Toxidermias/terapia , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Irritantes/efeitos adversos , Antineoplásicos/farmacologia , Toxidermias/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , HumanosRESUMO
BACKGROUND: The ideal method for management of the subscapularis tendon during anatomic total shoulder arthroplasty (TSA) remains controversial. METHODS: In a retrospective cohort study, primary anatomic TSA procedures performed with either a subscapularis peel or a lesser tuberosity osteotomy from 2002 to 2010 were reviewed at a minimum 1-year follow-up. The primary outcome measure was the performance of a normal lift-off test postoperatively. Multivariate logistic regression analysis was performed to determine if other covariates besides surgical technique correlated with an abnormal lift-off test result. RESULTS: Ninety TSA procedures were evaluated. Forty-six procedures were performed with subscapularis peel, and 44 were performed with lesser tuberosity osteotomy. Mean follow-up was 4 years. In the subscapularis peel group, 32 of 46 shoulders (69.6%) had a normal lift-off test, compared with 40 of 44 shoulders (90.9%) in the lesser tuberosity osteotomy group (P = 0.01). The results of multivariate logistic regression suggested that lesser tuberosity osteotomy was associated with a normal postoperative lift-off test 4.5 times more often than was subscapularis peel. CONCLUSIONS: Our study suggests that the use of lesser tuberosity osteotomy as the surgical approach for anatomic TSA is a reliable option that provides the patient with a better chance of maintaining subscapularis function postoperatively than the subscapularis peel does. LEVEL OF EVIDENCE: Level III retrospective cohort study.
Assuntos
Artroplastia do Ombro/efeitos adversos , Osteotomia/métodos , Complicações Pós-Operatórias/fisiopatologia , Artroplastia do Ombro/métodos , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Estudos Retrospectivos , Manguito Rotador/fisiopatologia , Manguito Rotador/cirurgia , Resultado do TratamentoRESUMO
PURPOSE OF THE REVIEW: Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. RECENT FINDINGS: Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.
Assuntos
Dermatoses da Mão/epidemiologia , Dermatoses da Mão/terapia , Verrugas/epidemiologia , Verrugas/terapia , Adolescente , Adulto , Distribuição por Idade , Bleomicina/administração & dosagem , Criança , Terapia Combinada , Crioterapia/métodos , Desbridamento , Fármacos Dermatológicos/administração & dosagem , Feminino , Dermatoses da Mão/diagnóstico , Humanos , Incidência , Injeções Intralesionais , Masculino , Prognóstico , Distribuição por Sexo , Dermatopatias Virais/diagnóstico , Dermatopatias Virais/epidemiologia , Dermatopatias Virais/terapia , Resultado do Tratamento , Verrugas/diagnóstico , Adulto JovemAssuntos
Cimentos Ósseos/uso terapêutico , Mãos/cirurgia , Polimetil Metacrilato/uso terapêutico , Extremidade Superior/cirurgia , Animais , Artroplastia de Substituição/métodos , Fenômenos Biomecânicos , Cimentos Ósseos/efeitos adversos , Elasticidade , Gentamicinas/efeitos adversos , Gentamicinas/uso terapêutico , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Metilmetacrilatos/efeitos adversos , Metilmetacrilatos/uso terapêutico , Osteomielite/cirurgia , Polimetil Metacrilato/efeitos adversos , Falha de Prótese , Vancomicina/efeitos adversos , Vancomicina/uso terapêuticoAssuntos
Herpes Simples/epidemiologia , Herpes Simples/virologia , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/virologia , Adolescente , Adulto , Distribuição por Idade , Antivirais/uso terapêutico , Criança , Educação Médica Continuada , Feminino , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/epidemiologia , Dermatoses da Mão/virologia , Herpes Simples/tratamento farmacológico , Humanos , Incidência , Masculino , Prognóstico , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Dermatopatias Infecciosas/tratamento farmacológico , Resultado do Tratamento , Adulto JovemRESUMO
The volar locking plate is a popular implant for surgical management of unstable distal radial fractures. We routinely utilize this system for all distal radial fractures except for those with entrapped intra-articular fragments and fractures with a displaced dorsomedial facet fracture (which is hard to capture with the volar approach alone). In this video, we describe in detail the necessary steps for successful placement of the volar locking plate, starting with preoperative planning and ending with expected outcomes. The approach that we utilize is through the flexor carpi radialis tendon sheath and avoids the radial artery. In the video, we describe 4 variations on the application of a volar locking plate: (1) the standard technique after appropriate reduction and provisional fixation with Kirschner wires, (2) regaining length through a shortened distal radial fracture, (3) using the volar plate to assist in the reduction and regain volar tilt, and (4) intraoperative management of coronal shift of the distal fragment. Complications reported for the volar locking plate have decreased with newer low-profile plate designs; however, they still include volar tendon irritation and/or rupture and median neuropathy. Postoperatively, we advise a brief 2-week period of immobilization for wound-healing, which is followed by a period during which a removable wrist splint is used and patients are instructed on the performance of a hand therapy regimen.
RESUMO
Reverse total shoulder arthroplasty was officially approved for use in the United States in 2003. The procedure is proving to be one of the most exciting advances in upper extremity surgery in the past quarter-century. The prosthesis is used to salvage the arthritic, unstable, rotator cuff-deficient shoulder and allow patients to obtain nearly pain-free overhead motion of the upper limb. This article reviews the previous literature and the results of 41 reverse shoulder arthroplasties implanted in 39 patients by a single orthopedically trained hand and upper extremity surgeon at a single institution from November 2004 until July 2011.