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A 63-year-old male presented with a trans-scaphoid lunate dislocation after a ten-foot fall. Internal fixation included placement of a dorsal spanning plate (DSP). One-year follow-up yielded a satisfactory outcome. A rigid DSP is a useful tool in acute perilunate injuries to protect internal fixation constructs and help with injury rehabilitation.
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An unhelmeted 59-year-old male involved in a motorcycle accident presented with a right dorsal lunate dislocation in the context of a polytrauma evaluation. Soft-tissue attachments were minimal across the carpus, which allowed for an en bloc proximal row carpectomy. Two-year follow-up yielded a satisfactory outcome given the high energy injury mechanism. Proximal row carpectomy is a useful tool which preserves wrist range of motion in the acute trauma setting and is durable, as demonstrated by our patient's postoperative mobilization using a wheelchair.
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INTRODUCTION: This study examines the relationship between smoking status and surgical outcomes in open carpal tunnel release. Smoking status has previously been correlated with orthopedic surgical complications unless smoking cessation occurs at least 4 weeks prior to surgery; however, the effect of smoking on open carpal tunnel release has not been specifically examined. METHODS: This study is a retrospective review of patient charts over the last 5 years (n = 131). Smoking status was determined at the time of carpal tunnel release from the patients' charts. Patients were dichotomized as smokers (n = 58) or non-smokers (n = 73). Data comprised preoperative pain, postoperative pain at 2 and 6 weeks, postoperative wrist stiffness, wound healing time, and infection status. Data were compared on chi square, Fisher exact, and one-sided Fisher exact tests. RESULTS: Infection rates were significantly higher in smokers. Postoperative numbness and wrist stiffness were also significantly higher in smokers. Smokers reported higher postoperative pain scores at 2 and 6 weeks. Non-smokers were also significantly more likely to report complete pain resolution at 6 weeks. DISCUSSION: In the present study smoking was associated with surgical outcome complications in open carpal tunnel release. This could be attributed to immune system suppression or to poor wound healing, both of which are known side-effects of smoking. Pain scores 6 weeks post-surgery were significantly higher in smokers than in non-smokers. Smokers undergoing open carpal tunnel release need to understand the risk of surgical complications and should consider smoking cessation to optimize their chances of successful surgery. CONCLUSION: Patients who were active smokers showed poorer recovery from open carpal tunnel surgery than non-smoking patients.
Assuntos
Síndrome do Túnel Carpal , Fumar , Humanos , Resultado do Tratamento , Fumar/efeitos adversos , Síndrome do Túnel Carpal/cirurgia , Estudos Retrospectivos , Dor Pós-OperatóriaRESUMO
Purpose: The purpose of this study was to determine whether a relationship exists between body mass index (BMI), specifically obesity, and surgical outcomes for open carpal tunnel release. Obesity is correlated with increased incidence of carpal tunnel syndrome; however, the effect of obesity on after release recovery has not been examined. Methods: This study used a retrospective review of patient charts (n = 142). BMI was calculated based on height and weight measurements, and patients were grouped based on their BMI into the following categories: healthy BMI (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity class one (30-34.9 kg/m2) (OB1), obesity class (2 35-39.9 kg/m2) (OB2), or obesity class three (40+ kg/m2) (OB3). Data were then complied on surgical outcomes by assessing preoperative pain, postoperative pain at 2 and 6 weeks, postoperative joint stiffness, wound healing time, and infection status. Data were analyzed using chi-square analyses and multivariable logistic regression to assess the differences in treatment outcomes while controlling for possible confounding variables. Results: Age at the time of release was found to be inversely correlated with BMI. Healthy BMI patients (n = 19) underwent release at an average age of 59.1 years, whereas OB3 (n = 30) underwent release at an average age of 46.9 years. The odds of improvement in pain were significantly lower in all three obesity groups when compared with healthy BMI at both 2 and 6 weeks after operation. Conclusions: Our results indicate that obesity may be positively correlated with earlier incidence of carpal tunnel syndrome requiring surgical intervention. These data also indicate the increased rates of postoperative complications in obese patients, particularly patients with OB3. Patients with OB3 need to understand these risks before undergoing open release. Further study should examine the impact of type 2 diabetes on carpal tunnel release recovery. Clinical relevance: The information included in this study may be used to guide surgeons and patients when considering the effect and potential improvement in outcomes that may come from addressing patient BMI before open carpal tunnel surgery.
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A 22-year-old female presented to our clinic with the redevelopment of compressive symptoms after undergoing right carpal tunnel release 2 years prior. During revision surgery, the application of a chitosan polysaccharide membrane wrap over the median nerve was secured with three hemoclips. Follow-up revealed that these clips traveled distally to the volar aspect of the patient's small finger necessitating excision. Hemoclips in hand surgery serve as a useful tool for securing constructs; however, the recommendation to use them sparingly is made because of the potential for migration and exacerbation of symptoms.
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Carpometacarpal (CMC) fracture-dislocations are uncommon hand injuries, with few studies available regarding their treatment. The current operative treatment options include fixation with K-wires, mini-screws, or plates, though there is no standardized approach because of varying injury patterns and complications associated with each device. The INnate™ threaded intramedullary nail is a relatively novel treatment option that has shown promise in metacarpal fracture fixation by facilitating faster mobilization and recovery with enhanced rotational stability and no compression to prevent fracture displacement and shortening. This study assesses the efficacy of the INnate™ nail for fixation of CMC fracture-dislocations of the second through fifth joints. Nine patients with fourteen CMC fracture-dislocations treated with the INnate™ nail at the University Medical Center between 2019 and 2021 were enrolled in the study. We evaluated postoperative outcomes in terms of pain, total active range of motion (TAM), and return to normal activities. Of the nine patients, seven returned for follow-up. The average time to radiographic union was 11.5 weeks. At final follow-up, no patient reported pain (n = 6). Four patients had 100% TAM, 1 had 95% TAM, and 1 had 25% TAM. The average percentage of normal activity resumed was 84.0% (n = 5). No significant complications were reported. One patient had a dorsal spanning plate; hence, we were unable to record outcomes measures regarding the CMC injury. An additional patient had diminished ROM of the injured hand, but his last follow-up was only 1 month postop. Our pilot data overall suggest that the INnate™ threaded intramedullary nail has the potential to improve treatment algorithms for CMC fracture-dislocations.
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Management of fingertip injuries in athletes is optimized by consideration of the sport, the playing position, the timing within the season, the level of competition, and the patient's goals. Mallet and jersey fingers are common injuries in athletes and may be treated in several different ways, based on the nature of the injury and the timing of presentation, as well as the athlete's demands. Management of fingertip injuries in musicians is optimized by consideration of how the musician handles his or her instrument and the specific requirements of the injured digit in the context of musical performance.
