Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia.

Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.

Outcomes of surgically treated distal radius fractures associated with triangular fibrocartilage complex injury.

STUDY DESIGN: Prospective cohort. INTRODUCTION: Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radius fractures expressed with the patient-rated disability are missing. The purpose of this study was to evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC. METHODS: Patients undergoing operative treatment for distal radius fracture were prospectively enrolled (n = 70). TFCC was examined by wrist arthroscopy and injuries classified according to Palmer. Comparative analyses were performed on 45 patients with TFCC injury (injured group) and 25 patients with intact TFCC (intact group). The outcome measures included the Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury. RESULTS: TFCC was injured in 45 patients (64%). In patients with intact TFCC, mean total PRWE score was 27 (3 months) and 16 (12 months), compared to patients with TFCC injury with 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 at 3 and 12 months for the intact group and 39 and 27 for the injured group. PRWE and DASH results showed significant difference at 3 and 12 months when compared with Mann-Whitney test. DISCUSSION: PRWE and DASH scores evaluation showed that patients with associated TFCC injury had greater pain and disability at 3 and 12 months after injury. CONCLUSIONS: Disability outcomes were worse in patients with distal radius fracture, where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radius fractures.

Outcomes of surgically treated distal radial fractures with associated triangular fibrocartilage complex injury.

STUDY DESIGN: Prospective cohort. INTRODUCTION: Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radial fractures expressed with the patient-rated disability are missing. PURPOSE OF THE STUDY: To evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC. METHODS: Patients undergoing operative treatment for distal radial fracture were prospectively enrolled (n = 70). The TFCC was examined by wrist arthroscopy, and injuries were classified according to Palmer. Comparative analyses were performed on data from 45 patients with TFCC injury (the injured group) and 25 patients with an intact TFCC (the intact group). The outcome measures included The Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury. RESULTS: The TFCC was injured in 45 patients (64%). In patients with an intact TFCC, the mean total PRWE score was 27 (at 3 months) and 16 (at 12 months), whereas in patients with TFCC injury, it was 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 for the intact group and 39 and 27 for the injured group at 3 and 12 months, respectively. PRWE and DASH results showed significant difference at 3 and 12 months when compared using the Mann-Whitney test. CONCLUSIONS: Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radial fractures.

Testicular infection in brucellosis: Report of 34 cases.

BACKGROUND/PURPOSE: To present clinical and laboratory features, treatment options, and outcome in patients with brucellar testicular infection and to compare them with analogous in brucellar patients without testicular involvement. METHODS: Thirty four brucellar patients with testicular infection treated in two general hospitals in the Republic of Macedonia, during the period 1998-2009, were retrospectively analyzed. Their clinical and laboratory characteristics were compared with analogous in 364 male brucellar patients without testicular infection, who were treated at the same hospitals during the same time period. RESULTS: Brucellar testicular infection was evident in 34 (8.5%) out of 398 male patients with brucellosis. The median age of the patients was 46.5 years. In all patients testicular involvement was presented as an acute form with a median duration of 5 days (range, 2-14 days) prior to diagnosis. Twenty-three of the patients had at least one other simultaneous focal infection. After starting with the treatment testicular infection lasted a median 10 days, range 7-21 days. Brucellar patients with testicular infection when compared with other brucellar patients more frequently manifested fever (97% vs. 61%), concomitant spondylitis (32% vs. 16%), and urinary system involvement (12% vs. 2%). Also, the relapse rate in patients with testicular involvement was significantly higher (24% vs. 9%). CONCLUSION: In endemic regions brucellosis should be taken into consideration in any patient with testicular infection. Brucellar testicular involvement is usually characterized with a severe acute clinical presentation and a high percentage of relapses which entails the need of timely recognition and proper treatment duration of at least 60 days.

Analysis of the Hemoglobin Level Drop in Patients with Hip Fracture After Admission.

The studies that evaluated blood loss during hip surgery found a relatively small loss that does not explain the large hemoglobin drop postoperatively. The aim of this study was to determine the fall in hemoglobin level after admission and rehydration in patients with hip fractures and to identify the patients that need blood transfusion. This retrospective study included data on 374 patients with hip fracture with surgery delayed by more than 24 hours and complete blood count repeated prior to surgery after fluid resuscitation for a minimum of 24 hours. The hemoglobin level (g/L) was analyzed after admission and after rehydration. The results were compared by Student's t-test. The mean hemoglobin drop was 6.1 g/L, 12.05 g/L and 16.52 g/L for capsular, pertrochanteric and subtrochanteric fractures, respectively. This hemoglobin drop was statistically significant in all frac-ture types. The significant drop of preoperative hemoglobin should be taken in consideration when planning transfusion for hip fracture patients. Collection of blood sample after rehydration preopera-tively would enable prompt diagnosis and treatment of anemia in these patients, along with proper transfusion planning and cross-matching.

Influence of associated lesions of the intrinsic ligaments on distal radius fractures outcome.

INTRODUCTION: We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures. MATERIALS AND METHODS: This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6 months after injury. Grip strength was also evaluated. RESULTS: Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5 %). Mean total PRWE score for the intact group was 26.64 at 3 months and 16.22 at 6 months, and 50.47 (at 3 months) and 20.7 (at 6 months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6 months for the intact group, and 49.5 and 24.11 for the injured group. Mann-Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups. CONCLUSIONS: Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol.

Open reduction and internal fixation versus external fixation and/or kirschner wires for distal radius fractures. A systematic review.

UNLABELLED: The aim of this study was to compare open reduction and plate fixation in the treatment of distal radius fractures with percutaneous fixation methods (external fixation and/or K-wires) regarding the outcome, using self-reported questionnaires (PRWE--Patient rated wrist evaluation, DASH--Disabilities of the Arm, Shoulder and Hand) as a primary aim, and grip strength and radiological parameters as a secondary aim. DATA SOURCE: We performed a systematic review of available evidence through a search of the electronic Medline PubMed database. STUDY SELECTION: Randomized clinical trials were included, as well as nonrandomized retrospective studies if they directly compared percutaneous fixation with ORIF, in the last ten years. DATA EXTRACTION: Functional (PRWE, DASH), objective (grip strength), as well as radiographic outcomes were extracted and reported. DATA SYNTHESIS: Ten studies were analysed, a total of 647 distal radius fractures (DRF) were included in the meta-analysis, 140 fractures treated with external fixation, 179 with K-wires (total 319 percutaneous fixation), and 328 fractures treated with ORIF. The meta-analysis showed no statistically significant differences between the results for the DRF treatment with ORIF or percutaneous methods at 3, 6 and 12 months regarding PRWE scores and grip strength, as well as final radiological outcome (volar tilt, radial length, radial tilt, ulnar variance). At 3 and 6 months there was a significant difference in the DASH score favouring open reduction and plate fixation, but at 12 months the meta-analysis showed no significant difference between the two methods compared. CONCLUSIONS: The results of this meta-analysis for the operative treatment of distal radius fractures did not clearly demonstrate a relevant advantage of any of the fixation methods.