ABSTRACT
Magnetic resonance imaging (MRI) can evaluate nerve morphology in cubital tunnel syndrome (CuTS), but its value in predicting surgical outcome is unclear. The purpose of this study was to determine whether ulnar nerve morphology on MRI correlated with outcome after CuTS surgery. We reviewed 40 patients who had preoperative MRI and electrodiagnostic (EDX) examinations for CuTS and outcome evaluation 6 months and 2 years postoperatively. Using MRI, ulnar nerve cross-sectional area (UNCSA), changes in signal intensity, and any space-occupying lesion were evaluated. Other factors assessed were age, symptom duration and severity, type-2 diabetes and EDX parameters. Factors associated with unfavorable surgical outcome were identified. At 6 months postoperatively, 12 patients (30%) had excellent, 19 (47.5%) good, 8 (20%) fair and 1 (2.5%) poor results on modified Wilson-Krout criteria. On univariate analysis, unfavorable outcomes were associated with increased UNCSA, space-occupying lesion, and decreased motor nerve conduction velocity (mNCV), and on multivariate analysis with increased UNCSA 1 cm distal from the epicondyle only (model 1) or increased UNCSA 1 cm proximal from the epicondyle and decreased mNCV (model 2). At 2 years, 15 patients (37.5%) had excellent, 21 (52.5%) good, 3 (7.5%) fair and 1 (2.5%) poor results, and no factors correlated with unfavorable outcome. Increased UNCSA on MRI was associated with unfavorable outcome at 6 months but not at 2 years. This study suggests that morphologic ulnar nerve changes can predict delayed nerve recovery after surgery for CuTS.
Subject(s)
Cubital Tunnel Syndrome , Cubital Tunnel Syndrome/surgery , Humans , Magnetic Resonance Imaging , Ulnar Nerve/diagnostic imaging , Ulnar Nerve/surgeryABSTRACT
We investigated the effect of vitamin D supplementation on the expression of muscle vitamin D receptor (VDR) and cross-sectional area (CSA) in patients with a distal radius fracture (DRF). Significant increases in VDR expression and CSA were observed, especially in vitamin D-deficient patients. PURPOSE: Vitamin D supplementation is known to enhance muscle mass and function, but whether the VDR is essential in this process remains unknown. We evaluated the change in VDR expression and CSA in the forearm muscles following vitamin D supplementation in patients with a DRF. METHODS: We prospectively recruited 18 women with a median age of 63.5 years who have a DRF. We obtained two biopsies of the forearm muscle, first at the time of fracture repair and then during hardware removal. We supplemented 1000 IU of vitamin D per day during a median interval of 8 months. We examined the changes in VDR expression and CSA by immunohistochemistry. RESULTS: The median serum 25-hydroxyvitamin D [25(OH)D] increased from 14.3 to 32.1 ng/mL (P = 0.001). The median VDR expression increased from 0.72 to 0.78 (P = 0.002), and the median CSA increased from 1290.0 to 1685.8 µm2 (P = 0.022). Significant increases in VDR expression and CSA were observed in vitamin D-deficient patients [25(OH)D] < 20 ng/mL, but not in vitamin D-non-deficient patients. The changes in VDR expression and CSA were in the same direction in 13 patients, but in the opposite direction in 5 patients. CONCLUSION: Vitamin D supplementation may increase muscle VDR expression and CSA in patients with a DRF, especially in vitamin D-deficient patients. The increase in CSA without an increase in VDR expression in some patients indicates that the effect of vitamin D supplementation on muscle mass could be mediated by indirect effect of serum vitamin D restoration and by VDR.
Subject(s)
Radius Fractures , Receptors, Calcitriol/genetics , Vitamin D Deficiency , Calcifediol , Female , Humans , Middle Aged , Muscle, Skeletal , Vitamin D , Vitamin D Deficiency/drug therapyABSTRACT
We evaluated whether active osteoporosis care in patients experiencing their first distal radius fracture (DRF) reduces subsequent hip or spine fractures by comparing two cohorts. The incidence of subsequent fractures was significantly lower in the active care cohort than the other cohort in 4-year follow-up. PURPOSE: Studies show that osteoporosis care in patients with osteoporotic fracture reduces subsequent fractures, but the impact of such active care in patients with distal radius fracture (DRF) has not been well studied. We evaluated how much osteoporosis care in patients experiencing their first DRF can reduce subsequent hip or spine fractures at 4-year follow-up. METHODS: Active osteoporosis care by orthopedic surgeons for patients with DRF started from September 2009 at our institution, thus we had a unique opportunity to compare the two cohorts: pre-involvement (PreI) group (DRF before September 2009) and post-involvement (PostI) group (DRF from September 2009). We compared the two cohorts for subsequent hip or spine fracture incidence in the 4 years following DRF. RESULTS: Overall, 1057 patients with a DRF (85% women; mean age, 70 years) were studied, of whom 205 patients were in PreI group and 852 in PostI group. Subsequent fractures occurred in 27 patients (2.6%), with a mean interval of 29 months after DRF. The incidence was significantly lower in the PostI group than in the PreI group (1.9% vs. 5.4%, p = 0.004), especially in hip fractures (0.4% vs. 2.9%, p = 0.002). The relative risk reduction was 65% for all subsequent fractures and 86% for hip fractures. CONCLUSION: This study demonstrates that active osteoporosis care in patients with DRF significantly reduces subsequent fracture incidence even for the 4-year follow-up period. These findings add an evidence for the current proactive osteoporosis care programs such as fracture liaison services. LEVEL OF EVIDENCE: Therapeutic level III.
Subject(s)
Hip Fractures , Osteoporosis , Osteoporotic Fractures , Radius Fractures , Spinal Fractures , Aged , Female , Hip Fractures/epidemiology , Hip Fractures/etiology , Hip Fractures/prevention & control , Humans , Longitudinal Studies , Male , Osteoporosis/complications , Osteoporosis/epidemiology , Osteoporosis/therapy , Osteoporotic Fractures/epidemiology , Osteoporotic Fractures/etiology , Osteoporotic Fractures/prevention & control , Radius Fractures/complications , Risk Factors , Spinal Fractures/epidemiology , Spinal Fractures/etiology , Spinal Fractures/prevention & controlABSTRACT
Individuals with poor knowledge of osteoporosis and lower socioeconomic status, including being single and having a lower level of annual income, are less likely to be assessed or treated for osteoporosis. Individuals with particular osteoporosis risk factors such as smokers and heavy drinkers are overlooked for diagnosis. Further study is needed to identify and address the existing barriers and to promote osteoporosis management for women with these risk factors. INTRODUCTION: Despite the negative health consequences of osteoporosis and the availability of effective treatment, a pervasive and persistent prevention care gap for osteoporosis remains present throughout the world. We attempted to identify the factors affecting the willingness of patients to either undergo or avoid assessment and treatment for osteoporosis. METHODS: A nationwide online survey was conducted in 926 Korean women over age 50. The survey included questions addressing three domains: (1) clinical and socio-demographic characteristics, (2) questions concerning the reasons for undergoing or avoiding osteoporosis assessment or treatment, and (3) knowledge of osteoporosis as measured using the modified Korean version of Facts on Osteoporosis Quiz. The assessed and non-assessed participants were compared in terms of their clinical and socioeconomic statuses, reasons for undergoing or avoiding osteoporosis management, and levels of knowledge of osteoporosis. RESULTS: The highest-ranked reason for undergoing osteoporosis assessment was fear of osteoporotic fracture, while the highest-ranked reason for avoiding osteoporosis assessment was not feeling a need to get tested for osteoporosis. Participants who sought assessment for osteoporosis were older and more likely to be married, and had greater knowledge of osteoporosis than those who did not seek assessment. The two groups were found to be similar in terms of tobacco use and daily alcohol use. Patients who had been diagnosed with osteoporosis but either did not initiate or discontinued osteoporosis treatment within 1 year were younger and had lower levels of annual income than those who began and continued treatment. CONCLUSION: Individuals with poor knowledge of osteoporosis and those of lower socioeconomic status, including those who were single and had a lower level of annual income, were less likely to be assessed and treated for osteoporosis. Individuals with particular osteoporosis risk factors such as smokers and heavy drinkers are overlooked for diagnosis. Further study is needed to identify and address the existing barriers and to promote osteoporosis management for women with these risk factors.
Subject(s)
Health Knowledge, Attitudes, Practice , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/drug therapy , Patient Acceptance of Health Care/psychology , Aged , Bone Density Conservation Agents/therapeutic use , Cross-Sectional Studies , Female , Humans , Middle Aged , Osteoporosis, Postmenopausal/etiology , Osteoporosis, Postmenopausal/psychology , Osteoporotic Fractures/prevention & control , Republic of Korea , Risk Factors , Socioeconomic Factors , Surveys and QuestionnairesABSTRACT
AIMS: The aim of this study was to compare the efficacy of a corticosteroid injection for the treatment of carpal tunnel syndrome (CTS) in patients with and without Raynaud's phenomenon. PATIENTS AND METHODS: In a prospective study, 139 patients with CTS were treated with a corticosteroid injection (10 mg triamcinolone acetonide); 34 had Raynaud's phenomenon and 105 did not (control group). Grip strength, perception of touch with a Semmes-Weinstein monofilament and the Boston Carpal Tunnel Questionnaires (BCTQ) were assessed at baseline and at six, 12 and 24 weeks after the injection. The Cold Intolerance Severity Score (CISS) questionnaire was also assessed at baseline and 24 weeks after the injection. RESULTS: The two groups had similar baseline BCTQ scores, but the scores in the Raynaud's phenomenon group were significantly higher than those in the control group at 12 and 24 weeks after the injection. Throughout the 24-week follow-up, there were no significant differences in the mean grip strength between the groups, whereas the mean Semmes-Weinstein monofilament sensory index for the control group was significantly higher than that of the Raynaud's phenomenon group. The mean CISSs were not significantly different between the groups at baseline and at 24 weeks. After 24 weeks, 11 patients (32%) in the Raynaud's phenomenon group and 16 (15%) in the control group required carpal tunnel decompression (p = 0.028). Multivariable analysis indicated that concurrent Raynaud's phenomenon (odds ratio (OR) 2.6) and severe electrophysiological grade (OR 2.1) were independently associated with a failure of treatment after a corticosteroid injection. CONCLUSION: Although considerable improvements in symptoms will probably occur in patients with Raynaud's phenomenon who have CTS, they have higher risk of poor functional outcomes and failure of treatment than those without Raynaud's phenomenon. Cite this article: Bone Joint J 2017;99-B:1637-42.
Subject(s)
Carpal Tunnel Syndrome/drug therapy , Glucocorticoids/administration & dosage , Raynaud Disease/etiology , Triamcinolone Acetonide/administration & dosage , Adult , Carpal Tunnel Syndrome/complications , Female , Humans , Injections , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
Metabolic syndrome is a constellation of medical conditions that arise from insulin resistance and abnormal adipose deposition and function. In patients with metabolic syndrome and De Quervain tenosynovitis this might affect the outcome of treatment by local corticosteroid injection. A total of 64 consecutive patients with De Quervain tenosynovitis and metabolic syndrome treated with corticosteroid injection were age- and sex-matched with 64 control patients without metabolic syndrome. The response to treatment, including visual analogue scale score for pain, objective findings consistent with De Quervain tenosynovitis (tenderness at first dorsal compartment, Finkelstein test result), and Disability of the Arm, Shoulder, and Hand score were assessed at 6, 12, and 24 weeks follow-up. Treatment failure was defined as persistence of symptoms or surgical intervention. Prior to treatment, patients with metabolic syndrome had mean initial pain visual analogue scale and Disability of the Arm, Shoulder, and Hand scores similar to those in the control group. The proportion of treatment failure in the metabolic syndrome group (43%) was significantly higher than that in the control group (20%) at 6 months follow-up. The pain visual analogue scale scores in the metabolic syndrome group were higher than the scores in the control group at the 12- and 24-week follow-ups. The Disability of the Arm, Shoulder, and Hand scores of the metabolic syndrome group were higher (more severe symptoms) than those of the control group at the 12- and 24-week follow-ups. Although considerable improvements in symptom severity and hand function will likely occur in patients with metabolic syndrome, corticosteroid injection for De Quervain tenosynovitis is not as effective in these patients compared with age- and sex-matched controls in terms of functional outcomes and treatment failure. LEVEL OF EVIDENCE: III.
Subject(s)
De Quervain Disease/complications , De Quervain Disease/drug therapy , Glucocorticoids/therapeutic use , Metabolic Syndrome/complications , Triamcinolone Acetonide/therapeutic use , Adult , Cohort Studies , De Quervain Disease/physiopathology , Female , Humans , Injections, Intra-Articular , Male , Middle Aged , Recovery of Function , Treatment Outcome , Young AdultABSTRACT
We compared bone mineral density (BMD) and trabecular bone score (TBS) in postmenopausal women with a distal radius fracture older than 50 years with controls. Total hip BMD was significantly different, but TBS was not different between two groups, suggesting TBS does not reflect microarchitectural changes of the distal radius. INTRODUCTION: The purpose of this study was to determine whether trabecular bone score (TBS) has additive value for discriminating distal radius fracture (DRF) independent of BMD. METHODS: We compared BMD and TBS in 258 postmenopausal women with a DRF older than 50 years of age with age- and body mass index (BMI)-matched controls who had no history of osteoporotic fracture. BMD was measured at the lumbar spine and hip using dual energy X-ray absorptiometry scans (GE Lunar Prodigy). TBS was calculated on the same spine image. A multivariate logistic regression analysis was used to analyze the odds ratio (OR) for the occurrence of DRF using age, BMI, lumbar spine BMD, total hip BMD, and TBS. RESULTS: Patients with a DRF had significantly lower BMDs at hip (neck, trochanter and total) than those of controls: 0.752 ± 0.097, 0.622 ± 0.089, and 0.801 ± 0.099 in patients and 0.779 ± 0.092, 0.648 ± 0.089, 0.826 ± 0.101 in controls. However, lumbar spine BMD and TBS were not significantly different between the groups (p = 0.400 and 0.864, respectively). The multivariate analysis indicated that only total hip BMD was significantly associated with the occurrence of DRF (OR, 10.231; 95 % confidence interval, 1.724-60.702; p = 0.010). CONCLUSIONS: TBS was not different between women with a DRF and those without a history of osteoporotic fracture, suggesting that TBS measured at the lumbar spine does not reflect early microarchitectural changes of the distal radius. Only total hip BMD is associated with the risk of DRF in Korean women.
Subject(s)
Bone Density , Cancellous Bone/pathology , Osteoporotic Fractures/pathology , Radius Fractures/pathology , Absorptiometry, Photon , Aged , Case-Control Studies , Female , Humans , Lumbar Vertebrae , Middle Aged , PostmenopauseABSTRACT
Diffuse peripheral nerve impairment is common in metabolic syndrome: in patients with metabolic syndrome and carpal tunnel syndrome this might affect the outcome of treatment by local corticosteroid injection. A total of 55 consecutive patients with carpal tunnel syndrome and metabolic syndrome treated with corticosteroid injection (10 mg triamcinolone acetonide) were age and sex matched with 55 control patients without metabolic syndrome. Grip strength, perception of touch with Semmes-Weinstein monofilaments and Boston Carpal Tunnel Questionnaires were assessed at the baseline and at 6, 12 and 24 weeks follow-up. The two groups had similar pre-operative grip strength and Boston Carpal Tunnel Questionnaire scores. The Boston Carpal Tunnel Questionnaire symptom and function scores of the metabolic syndrome group were significantly greater than the control group at 12 and 24 weeks follow-up. Except for significantly greater grip strength at the 12-week follow-up in the control group, there were no significant differences in grip strength between the groups. Semmes-Weinstein monofilament sensory index for the control group was significantly greater than that of the metabolic syndrome group throughout the 24-week follow-up. After 24 weeks, five patients (13%) in the control group and 13 patients (27%) in the metabolic syndrome group had had carpal tunnel surgery. Patients with metabolic syndrome are at risk for poor functional outcome and failure of treatment after corticosteroid injection for carpal tunnel syndrome. LEVEL OF EVIDENCE: Treatment benefits III.
Subject(s)
Carpal Tunnel Syndrome/complications , Carpal Tunnel Syndrome/drug therapy , Glucocorticoids/therapeutic use , Metabolic Syndrome/complications , Triamcinolone Acetonide/therapeutic use , Adult , Case-Control Studies , Female , Hand Strength , Humans , Injections, Intra-Articular , Male , Middle Aged , Surveys and Questionnaires , Treatment OutcomeSubject(s)
Carpometacarpal Joints/diagnostic imaging , Carpometacarpal Joints/physiopathology , Joint Instability/diagnostic imaging , Joint Instability/etiology , Thumb , Adult , Aged , Female , Humans , Joint Instability/physiopathology , Middle Aged , Range of Motion, Articular , Surface PropertiesABSTRACT
UNLABELLED: Studies suggest that vitamin D has a role in neuroprotection. We investigated whether vitamin D status is associated with carpal tunnel syndrome. Vitamin D levels were compared between carpal tunnel syndrome women (n = 135) and healthy control women (n = 135) or patients with other upper limb conditions (n = 135). There were no differences in vitamin D levels between the patients with carpal tunnel syndrome and the controls. However, women with carpal tunnel syndrome younger than 50 years old had significantly lower vitamin D levels than age-matched healthy control women (P = 0.023) or patients with other upper limb conditions (P = 0.035). When women with carpal tunnel syndrome and healthy control women were pooled, the incidence of carpal tunnel syndrome was higher in vitamin D deficient women than in non-deficient women, especially in those younger than 50 years. This study suggests a potential link between vitamin D status and the occurrence of carpal tunnel syndrome in women younger than 50 years but causation is not established. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic Level III.
Subject(s)
Carpal Tunnel Syndrome/blood , Carpal Tunnel Syndrome/epidemiology , Vitamin D Deficiency/complications , Vitamin D/analogs & derivatives , Adult , Age Factors , Case-Control Studies , Female , Humans , Incidence , Middle Aged , Sex Factors , Vitamin D/blood , Vitamin D Deficiency/diagnosisABSTRACT
Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients.
Subject(s)
Amputation, Surgical/methods , Foot Deformities, Congenital/surgery , Adolescent , Child , Child, Preschool , Female , Follow-Up Studies , Foot Deformities, Congenital/diagnostic imaging , Humans , Infant , Male , Radiography , Surveys and Questionnaires , Time Factors , Treatment OutcomeABSTRACT
This study investigates the question of whether open repair of acute distal radioulnar joint instability at the time of volar plating of distal radius fractures would enable early mobilization of the wrist without the risk of distal radioulnar joint instability. We evaluated 29 patients of mean age 53 years with a distal radius fracture and acute distal radioulnar joint instability who underwent volar plating of the radius combined with surgical repair of the triangular fibrocartilage complex or an ulnar styloid base fracture, followed by active motion exercise of the wrist at 1 week after surgery. At 1 year after treatment, all patients had a stable distal radioulnar joint and grip strength averaged 90% of the normal side. This study demonstrates that surgical repair of the triangular fibrocartilage complex or ulnar styloid fracture followed by early mobilization did not result in distal radioulnar joint instability, and suggests that the surgical treatment of distal radioulnar joint instability may permit early mobilization of the wrist in patients who are considered suitable for rapid rehabilitation after surgery. Type of study: Therapeutic Level IV.
Subject(s)
Fracture Fixation, Internal , Joint Instability/etiology , Joint Instability/surgery , Radius Fractures/complications , Radius Fractures/surgery , Wrist Joint , Adult , Aged , Bone Plates , Female , Follow-Up Studies , Humans , Male , Middle Aged , Suture Techniques , Treatment Outcome , Triangular Fibrocartilage/surgeryABSTRACT
AIM: To compare motion of the capitate, scaphoid, and lunate in wrists with a malunited distal radius and contralateral normal wrists during dart-throwing motion (DTM) by three-dimensional kinematic studies using computed tomography (CT) images. MATERIALS AND METHODS: CT was performed simultaneously on both wrists in six patients with a unilateral distal radius malunion at three stepwise positions simulating DTM. Using volume registration technique, the kinematic variables of helical axis motion of the capitate, scaphoid, and lunate were calculated and compared between both wrists. The helical motion of the capitate was also evaluated in a scaphoid- and lunate-based coordinate system. RESULTS: Among the average rotation and translation of the scaphoid, lunate, and capitate during DTM, only the average rotation of the capitate was significantly different between the uninjured (88.9°) and the injured (70°) wrist (p = 0.0075). Rotation of the capitate relative to the scaphoid (26.3° versus 37.8°, p = 0.029) or lunate (39.2° versus 59.3°, p = 0.028) was smaller in the malunited wrist. The centres of helical axis motion of the three carpal bones were located more dorsally and radially in the injured wrist. CONCLUSIONS: The present study showed that decreased DTM in wrists with a distal radius malunion resulted from decreased midcarpal motion. The present study of the capitate, scaphoid, and lunate in wrists with distal radius malunion might be the first to present a 3D kinematic analysis of the effect of distal radius malunion on the carpal bones.
Subject(s)
Fractures, Malunited/physiopathology , Imaging, Three-Dimensional , Radius Fractures/physiopathology , Range of Motion, Articular , Tomography, X-Ray Computed , Wrist Injuries/physiopathology , Aged , Aged, 80 and over , Biomechanical Phenomena , Carpal Bones/physiopathology , Female , Fractures, Malunited/diagnostic imaging , Humans , Male , Middle Aged , Motion , Radius/physiopathology , Radius Fractures/diagnostic imaging , Task Performance and Analysis , Ulna/physiopathology , Wrist Injuries/diagnostic imagingABSTRACT
As carpal tunnel syndrome is more common in women, particularly around the menopause, female-related risk factors are suspected to play a role in its pathogenesis. We have assessed whether female hormone-related symptoms are associated with upper extremity disabilities in women undergoing carpal tunnel release. A total of 92 women with a mean age of 53 years scheduled for surgery for carpal tunnel syndrome were assessed preoperatively for female hormone-related symptoms using the menopausal rating scale and other female-related factors such as menopausal status, pregnancy number and serum female hormone levels. Upper extremity disability was evaluated using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. DASH scores had a moderate correlation with total menopausal rating scale scores, but not with other female-related factors assessed. This study suggests that female hormone-related symptoms are associated with subjective upper extremity disabilities in women with carpal tunnel syndrome. This information may be helpful in addressing patients' complex symptoms or interpretation of outcomes in women with carpal tunnel syndrome.
Subject(s)
Carpal Tunnel Syndrome/blood , Gonadotropins, Pituitary/blood , Menopause/blood , Adult , Aged , Carpal Tunnel Syndrome/surgery , Disability Evaluation , Female , Humans , Middle Aged , Republic of Korea , Risk Factors , Surveys and QuestionnairesABSTRACT
The purpose of this study was to evaluate the risk of late displacement after the treatment of distal radial fractures with a locking volar plate, and to investigate the clinical and radiological factors that might correlate with re-displacement. From March 2007 to October 2009, 120 of an original cohort of 132 female patients with unstable fractures of the distal radius were treated with a volar locking plate, and were studied over a follow-up period of six months. In the immediate post-operative and final follow-up radiographs, late displacement was evaluated as judged by ulnar variance, radial inclination, and dorsal angulation. We also analysed the correlation of a variety of clinical and radiological factors with re-displacement. Ulnar variance was significantly overcorrected (p < 0.001) while radial inclination and dorsal angulation were undercorrected when compared statistically (p < 0.001) with the unaffected side in the immediate post-operative stage. During follow-up, radial shortening and dorsal angulation progressed statistically, but none had a value beyond the acceptable range. Bone mineral density measured at the proximal femur and the position of the screws in the subchondral region, correlated with slight progressive radial shortening, which was not clinically relevant. Volar locking plating of distal radial fractures is a reliable form of treatment without substantial late displacement.
Subject(s)
Bone Plates , Fracture Fixation, Internal/methods , Osteoporotic Fractures/surgery , Radius Fractures/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Fracture Fixation, Internal/instrumentation , Fractures, Comminuted/diagnostic imaging , Fractures, Comminuted/pathology , Fractures, Comminuted/surgery , Humans , Middle Aged , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/pathology , Radiography , Radius Fractures/diagnostic imaging , Radius Fractures/pathology , Retrospective Studies , Treatment OutcomeABSTRACT
We retrospectively reviewed 633 hands in 362 patients who had idiopathic carpal tunnel syndrome and underwent carpal tunnel release between 1999 and 2009. Electrophysiological studies and simple radiographs of the wrist, cervical spine, and basal joint of the thumb were routinely checked, and patients were also assessed for the presence of trigger digit or de Quervain's disease before and after surgery. Among 362 patients, cervical arthritis was found in 253 patients (70%), and C5-C6 arthritis was the most common site. Basal joint arthritis of the thumb was observed in 216 (34%) of the 633 hands. Trigger digit or de Quervain's disease was observed in 85 of the 633 hands (13%) before surgery, and developed in 67 hands (11%) after surgery. Cervical arthritis, basal joint arthritis, and trigger digit commonly coexist with idiopathic carpal tunnel syndrome. Patient education about these disorders is very important when they coexist with idiopathic carpal tunnel syndrome.
Subject(s)
Arthritis/complications , Carpal Tunnel Syndrome/complications , Cervical Vertebrae , De Quervain Disease/complications , Hand Joints , Trigger Finger Disorder/complications , Age Factors , Aged , Arthritis/diagnosis , Arthritis/therapy , Carpal Tunnel Syndrome/diagnosis , Carpal Tunnel Syndrome/surgery , De Quervain Disease/diagnosis , De Quervain Disease/therapy , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Sex Factors , Trigger Finger Disorder/diagnosis , Trigger Finger Disorder/therapyABSTRACT
We reviewed retrospectively seven patients with Apert acrosyndactyly and measured the size of the capitate ossification centre relative to that of the hamate and determined the relative position of the middle finger metacarpal relative to the ring finger metacarpal. We then compared those parameters in 197 normal children. In all patients, the middle finger metacarpal bone had migrated proximally relative to the ring finger metacarpal and the size of the capitate ossification centre was smaller than that of the hamate. After surgical release of the middle finger, relative proximal migration of the middle finger metacarpal was partially relieved and catch-up growth of the capitate was observed within several months. As fusion of the distal phalanges creates a diamond-shaped configuration, bone growth is markedly impaired in the middle finger ray. Therefore, early separation of the middle finger may be as important as early separation of the border digits.
Subject(s)
Acrocephalosyndactylia/diagnostic imaging , Hand Bones/abnormalities , Hand Bones/diagnostic imaging , Hand Bones/surgery , Acrocephalosyndactylia/surgery , Capitate Bone/abnormalities , Capitate Bone/diagnostic imaging , Case-Control Studies , Child , Child, Preschool , Female , Hamate Bone/abnormalities , Hamate Bone/diagnostic imaging , Humans , Infant , Infant, Newborn , Male , Metacarpal Bones/abnormalities , Metacarpal Bones/diagnostic imaging , Radiography , Plastic Surgery Procedures , Retrospective StudiesABSTRACT
This paper is to investigate the dosimetric characteristics of Helical Tomotherapy (HT), step-and-shoot intensity-modulated radiation therapy (SaS-IMRT) and three-dimensional conformal radiation therapy (3D-CRT) for the postoperative breast cancer as well as their dosimetric comparison of the normal tissues. CT images of 10 postoperative patients with early stage breast cancer were transferred into HT, SaS-IMRT and 3D-CRT planning systems respectively after the target region and normal tissues were outlined by the same physician to assure the contour consistency. Each prescribed dose for three different modalities of plans was given to a total of 50 Gy in 25 fractions. Doses and irradiated volumes in heart, lungs, as well as conformity index (CI) and homogeneity index (HI) were evaluated for detailed comparison. All three plans showed appropriate coverage for the prescribed target dose in the dosimetric comparison. The CI in HT and SaS-IMRT as well as 3D-CRT was 0.68 ± 0.12, 0.58 ± 0.08 and 0.40 ± 0.08, respectively. The HI were 1.10 ± 0.03, 1.14 ± 0.02 and 1.17 ± 0.04, which appeared intergroup significant differences (p < 0.05). V5, V10, as well as V20 of the heart were smallest in 3D-CRT than HT and SaS-IMRT. V5 of the ipsilateral lung was the smallest in 3D-CRT than HT and SaS-IMRT (p < 0.05); However, V20 and V30 were smaller in HT and SaS-IMRT than 3D-CRT (p < 0.05). V5 of the contralateral lung was the smallest in 3D-CRT than other groups, with V10~V30 were basically similar in numeric values with not obvious discrepancy. Comparing with SaS-IMRT and 3D-CRT, HT technique in treating breast cancer had the best conformity and homogeneity index as well as steepest dose gradient due to its highly modulated beamlets with rotational technique. The heart volume irradiated was the smallest in conventional 3D-CRT, with SaS-IMRT was the largest among the three techniques, as expected. The volume of the contralateral lung irradiated was the smallest in 3D-CRT than other groups. V5 of the ipsilateral lung was the smallest in 3D-CRT than other two groups. V10~V30 in HT and SaS-IMRT were similar and better than 3D-CRT dosimetrically. We conclude that HT technique had advantages over SaS-IMRT and 3D-CRT based on the dosimetric comparison in this study, especially in the high dose region of ipsilateral lung, target homogeneity and dose uniformity.
Subject(s)
Breast Neoplasms/radiotherapy , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Conformal/methods , Radiotherapy, Intensity-Modulated/methods , Tomography, Spiral Computed/methods , Breast Neoplasms/surgery , Combined Modality Therapy , Female , Heart , Humans , Lung , Radiotherapy Dosage , Retrospective StudiesABSTRACT
The outcome of surgery in patients with medial epicondylitis of the elbow is less favourable in those with co-existent symptoms from the ulnar nerve. We wanted to know whether we could successfully treat such patients by using musculofascial lengthening of the flexor-pronator origin with simultaneous deep transposition of the ulnar nerve. We retrospectively reviewed 19 patients who were treated in this way. Seven had grade I and 12 had grade IIa ulnar neuropathy. At a mean follow-up of 38 months (24 to 48), the mean visual analogue scale pain scores improved from 3.7 to 0.3 at rest, from 6.6 to 2.1 with activities of daily living, and from 7.9 to 2.3 at work or sports, and the mean disabilities of the arm, shoulder and hand scores improved from 42.2 to 23.5. These results suggest that this technique can be effective in treating patients with medial epicondylitis and coexistent ulnar nerve symptoms.
Subject(s)
Tennis Elbow/surgery , Ulnar Neuropathies/surgery , Adult , Aged , Elbow Joint/surgery , Female , Hand Strength , Humans , Male , Middle Aged , Muscle, Skeletal/surgery , Nerve Transfer/methods , Pain Measurement/methods , Pain, Postoperative , Retrospective Studies , Severity of Illness Index , Tennis Elbow/complications , Treatment Outcome , Ulnar Nerve/surgery , Ulnar Neuropathies/etiologyABSTRACT
We treated 32 displaced mallet finger fractures by a two extension block Kirschner-wire technique. The clinical and radiological outcomes were evaluated at a mean follow-up of 49 months (25 to 84). The mean joint surface involvement was 38.4% (33% to 50%) and 18 patients (56%) had accompanying joint subluxation. All 32 fractures united with a mean time to union of 6.2 weeks (5.1 to 8.2). Congruent joint surfaces and anatomical reduction were seen in all cases. The mean flexion of the distal interphalangeal joints was 83.1 degrees (75 degrees to 90 degrees ) and the mean extension loss was 0.9 degrees (0 degrees to 7 degrees ). No digit had a prominent dorsal bump or a recurrent mallet deformity. We believe that this technique, when properly applied, produces satisfactory results both clinically and radiologically.