RESUMEN
Impaction fracture subluxation of the pisotriquetral joint producing arthrosis and ulnar triquetral osteochondral nonunion is a cause for ulnar wrist pain in batting athletes. Two cases of adolescent female softball players managed successfully with pisiform and triquetral fragment excision are reported.
Asunto(s)
Béisbol , Articulaciones del Carpo , Luxaciones Articulares , Osteoartritis , Hueso Pisiforme , Hueso Piramidal , Adolescente , Articulaciones del Carpo/cirugía , Femenino , Humanos , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/etiología , Luxaciones Articulares/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/etiología , Osteoartritis/cirugía , Hueso Pisiforme/diagnóstico por imagen , Hueso Pisiforme/cirugía , Hueso Piramidal/diagnóstico por imagen , Hueso Piramidal/cirugía , Articulación de la Muñeca/diagnóstico por imagenRESUMEN
PURPOSE: Distal condylar phalangeal (DCP) fractures in children are uncommon, but their periarticular location makes them problematic. Malunions are particularly difficult to treat. These fractures are generally thought to have a poor remodeling potential because their location is far from the phalangeal physis. We present 8 cases of DCP malunion in children with a mean 5-year follow-up demonstrating consistent remodeling. METHODS: In this study, DCP fractures were defined as those occurring at or distal to the collateral ligament recess of the proximal or middle phalanx in skeletally immature patients. Radiographic parameters examined at the time of established malunion and at final follow-up included coronal and sagittal plane deformity and translational malalignment of the distal fragment in relation to the proximal shaft. Range of motion was measured, and a brief questionnaire was implemented to establish patient satisfaction. RESULTS: We examined 8 patients with a minimum 1-year follow-up (mean, 5.3 y). Average age at injury was 8.8 years (range, 2-14 y). In the sagittal plane, fractures remodeled from an initial mean deformity of 30.9° to 0.0°; in the coronal plane, from 10.5° to 3.9°. Fracture translation in the sagittal plane corrected, as well, from a mean 57.5% at injury to 0.0% at final follow-up. There was no functionally limiting loss of motion of the digit in any patient. Subjectively, only 2 patients complained of cosmetic deformity, both of which were coronal plane deformities of the small finger. CONCLUSIONS: In this case series, DCP malunions in children remodeled significantly and completely in the sagittal plane, and all patients had good final range of motion. Furthermore, patients were satisfied with nonsurgical treatment at long-term follow-up. This series describes the remodeling potential of DCP fractures in children, lending support to the previously reported cases. These findings support treating late-presenting pediatric DCP malunions nonsurgically. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Asunto(s)
Remodelación Ósea/fisiología , Falanges de los Dedos de la Mano/lesiones , Fracturas Óseas/terapia , Fracturas Mal Unidas/terapia , Monitoreo Fisiológico/métodos , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Falanges de los Dedos de la Mano/diagnóstico por imagen , Estudios de Seguimiento , Fracturas Óseas/diagnóstico por imagen , Fracturas Mal Unidas/diagnóstico por imagen , Humanos , Masculino , Satisfacción del Paciente , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función/fisiología , Factores de Riesgo , Muestreo , Factores de TiempoAsunto(s)
Dedos/anatomía & histología , Tendones/anatomía & histología , Femenino , Humanos , MasculinoRESUMEN
Promethazine injections have led to necrosis and gangrene of the distal upper extremity when inadvertently injected into an artery. There have been few case reports of this alarming complication in the literature. We report on 2 cases of intra-arterial promethazine injection that led to amputation.
Asunto(s)
Brazo/irrigación sanguínea , Brazo/patología , Arteria Braquial/efectos de los fármacos , Dedos/irrigación sanguínea , Dedos/patología , Mano/irrigación sanguínea , Mano/patología , Antagonistas de los Receptores Histamínicos H1/toxicidad , Inyecciones Intraarticulares/efectos adversos , Isquemia/inducido químicamente , Prometazina/toxicidad , Arteria Radial/efectos de los fármacos , Arteria Cubital/efectos de los fármacos , Adulto , Amputación Quirúrgica , Angiografía , Arteria Braquial/diagnóstico por imagen , Femenino , Antagonistas de los Receptores Histamínicos H1/administración & dosificación , Humanos , Isquemia/diagnóstico por imagen , Errores de Medicación , Necrosis , Prometazina/administración & dosificación , Arteria Radial/diagnóstico por imagen , Arteria Cubital/diagnóstico por imagenRESUMEN
Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease (RDD), is a rare non-neoplastic pathologic condition that frequently pursues a prolonged clinical course marked by exacerbations and remissions. Cutaneous RDD is even less common than cases involving lymph nodes. We present the case of a patient with long-standing Crohn's disease who developed cutaneous RDD in the forearm.
Asunto(s)
Antebrazo , Histiocitosis Sinusal/patología , Enfermedades Linfáticas/patología , Enfermedades de la Piel/patología , Trasplante de Piel/métodos , Adulto , Biopsia con Aguja , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Estudios de Seguimiento , Histiocitosis Sinusal/complicaciones , Histiocitosis Sinusal/cirugía , Humanos , Inmunohistoquímica , Imagen por Resonancia Magnética , Recurrencia , Reoperación , Índice de Severidad de la Enfermedad , Enfermedades de la Piel/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: We report a series of pisotriquetral arthritis cases following wrist and intercarpal arthrodesis, offer an anatomic and biomechanical rationale, and introduce intraoperative considerations to avoid this potential complication. METHODS: Nine patients with pisotriquetral arthritis requiring pisiform excision following wrist and intercarpal arthrodesis were retrospectively evaluated at 2 institutions. Five paired cadaver wrists were tested for alterations in pressure and kinematics of the pisotriquetral joint following four-corner and total wrist fusions. RESULTS: Nine patients were successfully treated with pisiform excision for pisotriquetral arthritis following wrist and intercarpal fusions. Biomechanical cadaver testing demonstrated profound alterations in pisotriquetral kinematics and pressure changes in measured degrees of wrist position following wrist and intercarpal fusions. CONCLUSIONS: Patients undergoing four-corner and/or wrist arthrodesis should be assessed for pisotriquetral discomfort before surgery, including a physical examination and a 30 degrees supinated radiograph to look for degenerative changes. Attempts should be made intraoperatively to ensure that the proximal row is not fused in an extended position. After surgery, if discomfort develops and conservative treatment fails, then pisiform excision can successfully alleviate the pain.
Asunto(s)
Artrodesis/efectos adversos , Articulaciones del Carpo/fisiopatología , Hueso Pisiforme/fisiopatología , Hueso Piramidal/fisiopatología , Articulación de la Muñeca/cirugía , Adulto , Anciano , Artritis/fisiopatología , Artritis/cirugía , Artrodesis/instrumentación , Artrodesis/métodos , Fenómenos Biomecánicos , Cadáver , Articulaciones del Carpo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Hueso Pisiforme/diagnóstico por imagen , Hueso Pisiforme/cirugía , Presión , Radiografía , Estudios Retrospectivos , Hueso Piramidal/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatologíaRESUMEN
Necrotizing soft tissue infections encompass a wide variety of clinical syndromes resulting from introduction of various pathogens into injured or devitalized tissue. The extent of microbial involvement in such tissue may range from simple contamination to overt and progressive local tissue necrosis, which, if untreated, may lead to septicemia and death. Early differentiation among these infections is not always possible, as there are overlapping classification criteria. These infections exist along a continuum of clinical severity with different etiological agents and associated medical conditions. The often subtle clues heralding the presence of a necrotizing soft tissue infection must be sought so that expeditious surgical debridement and broad-spectrum antibiotic management are initiated. Although experience enables the clinician to make a specific diagnosis based on early findings, aggressive and proper treatment of suspected infections remains the priority. The purpose of the article is to provide an overview of necrotizing soft tissue infections in the upper extremity, focusing on gas gangrene, or clostridial myonecrosis, and necrotizing fasciitis, to facilitate early diagnosis and optimal management of these lethal diseases.