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Purpose: Tibial plateau fracture (TPF) is a complex intra-articular injury involving comminution and depression of the joint, which can be accompanied by meniscal tears. The aims of this study were (1) to demonstrate the rate at which surgical treatment for lateral meniscal injury and (2) to clarify the explanatory radiographic factors associated with meniscal injury in patients with TPF. Methods: We extracted the patients who received surgical treatment for TPF from our multicenter database (named TRON) included from 2011 to 2020. We analyzed 79 patients who were received surgical treatment for TPF with Schatzker type II and III and evaluation for meniscal injury on arthroscopy. We investigated the rate at which surgical treatment of the lateral meniscus was required in patients with TPF and the explanatory radiographic factors associated with meniscal injury. Radiographs and CT scans were evaluated to measure the following parameters: tibial plateau slope, distance from lateral edge of the articular surface to fracture line (DLE), articular step, and width of articular bone fragment (WDT). Meniscus tears were classified according to whether surgery was necessary. The results were analyzed by multivariate Logistic analyses. Results: We showed that 27.7% (22/79) of cases of TPF with Schatzker type II and III had lateral meniscal injury that required repair. WDT ≥ 10 mm (odds ratio 10.9; p = 0.005) and DLE ≥ 5 mm (odds ratio 5.7; p = 0.05) were independent explanatory factors for meniscal injury with TPF. Conclusion: Bone fragment size and the location of fracture line on radiographs in patients with TPF are associated with meniscus injuries requiring surgery. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00888-5.
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This study assessed the risk factors for spontaneous extensor tendon rupture in the rheumatoid wrist. The rupture group consisted of 25 wrists that had rupture of the extensor tendons and later received tendon reconstruction. The non-rupture group included 77 rheumatoid wrists without extensor tendon rupture. We assessed patients' pain at the distal radioulnar joint and swelling in the extensor tendon compartments clinically, matrix metalloproteinase-3 level in blood samples, and radiographic findings. We found that swelling in the extensor tendon compartments, the scallop sign, and severe dorsal subluxation are significantly associated with spontaneous extensor tendon rupture, but serum matrix metalloproteinase-3 level is not.Level of evidence: IV.
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Artrite Reumatoide , Punho , Artrite Reumatoide/complicações , Humanos , Fatores de Risco , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Ruptura Espontânea/cirurgia , Tendões/diagnóstico por imagem , Tendões/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgiaRESUMO
We investigate changes in brain function before and after carpal tunnel release. Magnetoencephalography (MEG), during which we recorded somatosensory evoked cortical magnetic fields (SEFs), and a clinical evaluation were performed before surgery and 6 months after. The distance on the vertical axis between the equivalent current dipoles (ECDs) for the first and third digits before surgery was significantly less than after surgery. There were no significant differences in values between the control participant and patients after surgery. In terms of distal motor latency, there was a negative correlation with the distance. The recovery function of the root mean square (RMS) before surgery for the N20m was less suppressed at 10 ms of ISI in patients, compared to controls. There were no significant differences in the RMS values for patients before and after surgery. Our results indicate that treating peripheral nerve lesions, such as in carpal tunnel release, positively modifies brain function.
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Síndrome do Túnel Carpal/fisiopatologia , Potenciais Somatossensoriais Evocados , Magnetoencefalografia , Córtex Somatossensorial/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Glomus tumors are relatively rare benign neoplasms that most commonly occur in the hand. They arise from the normal glomus body, which is an arteriovenous shunt related to thermoregulation. Glomus tumors in nerves are an extremely rare occurrence, as normal glomus bodies have not been found in nerves. We describe the case of a 30-year-old woman with a glomus tumor originating from a digital nerve that required excision along with a nerve segment. In this case, because the tumor was inseparable from both fascicles of the nerve, a segment of the ulnar digital nerve was resected with the tumor. After tumor resection, direct nerve repair was performed and the patient showed favorable outcomes.
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We report a patient of Scapholunate (SL) injury in which radiography revealed obvious SL dissociation with dorsal intercalated segment instability deformity, but arthroscopy showed a SL gap of less than 2 mm. Radiographs of the uninjured wrist showed a SL interval of 3.0 mm and a SL angle of 80°. Preoperative magnetic resonance imaging showed low signal intensity in the proximal portion of the scaphoid and a mild SL gap on T1-, T2-weighted, and T2-weighted fat-suppressed images. Midcarpal wrist arthrography revealed a small amount of contrast media leakage through the SL interval. It was considered that incomplete ossification of the scaphoid mimicked obvious radiographic SL dissociation.
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Doenças do Desenvolvimento Ósseo/diagnóstico por imagem , Osso Escafoide/diagnóstico por imagem , Adulto , Artroscopia , Articulações do Carpo/fisiopatologia , Feminino , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Osso Semilunar/diagnóstico por imagem , Imageamento por Ressonância Magnética , RadiografiaRESUMO
Background and Purpose Wrist swelling is a frequent clinical manifestation of Kienböck's disease, but no study has reported the site and pathology of wrist swelling in this disease. The aim of this study is to elucidate the site and pathology of wrist swelling in Kienböck's disease. Materials and Methods Dorsal and palmar soft tissue thicknesses of the wrist were measured on standard lateral radiographs of the wrist in 26 patients with Kienböck's disease and 30 subjects without intra-articular lesion. Axial magnetic resonance imaging (MRI) views were examined to detect the site of swelling. The dorsal capsular ligament in three patients with Kienböck's disease underwent histological examination. Results Radiographic study confirmed dorsal wrist swelling in 24 of 26 (92%) patients examined compared with the contralateral unaffected wrists. MRI demonstrated thickening of the dorsal capsular ligament and extensor layer with synovial proliferation. Histological examination revealed nonspecific chronic inflammation. Conclusion Dorsal wrist swelling in Kienböck's disease is a common manifestation and constitutes a part of pathology of Kienböck's disease, although further study is required to clarify the relation between wrist swelling and etiology of Kienböck's disease. Level of Evidence This is a Level III study.
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We describe a 59-year-old man who had nonunion of a right distal radius fracture after volar locking plate fixation. He underwent open reduction and internal fixation with a volar locking plate system for a dorsally displaced, unstable distal radius fracture at a previous hospital 5 months ago. Radiographs of the injured wrist showed nonunion of the distal radius with 1.5-mm ulnar minus variance. Radiographs of the unaffected wrist showed 3.5-mm ulnar plus variance. Intraoperative findings of surgical revision showed an unstable nonunion; thus, debridement of the nonunion, autogenous inlay bone grafting, and internal fixation using another type of volar locking plate system were performed. Healing of the re-operative site was confirmed radiographically 3 months postoperatively. We considered that volar locking plate fixation with excessive distraction of the fracture may lead to nonunion.
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Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-OperatórioRESUMO
We describe the case of a patient with distal radius fracture who became unable to flex the distal interphalangeal joint of the index finger after internal fixation using a volar locking plate. There was palpable crepitus with active thumb motion, and wrist radiographs showed prominence of the volar plate at the watershed line. Therefore, our initial diagnosis was plate-induced closed rupture of the flexor digitorum profundus tendon of the index finger. However, upon surgical removal of the plate, no tendon rupture was found. Magnetic resonance imaging after plate removal showed diffuse increased signal intensity in the index flexor digitorum profundus on T2-weighted fat-suppressed images, which indicated muscle denervation. Based on the above findings, we changed the diagnosis to anterior interosseous nerve palsy with isolated paralysis of the flexor digitorum profundus of the index finger. Finger flexion disability following volar plate fixation of distal radius fracture should always be investigated carefully..
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Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Adulto , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Masculino , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/cirurgiaRESUMO
We retrospectively reviewed 12 patients (3 men and 9 women, with a mean age of 72 years) who were surgically treated for carpal tunnel syndrome associated with Kienböck disease. All patients except 1 were incidentally diagnosed with Kienböck disease and had little or no wrist pain. Radiographic tests revealed advanced Kienböck disease in all patients. Intraoperative findings indicated that the site of maximum compression on the median nerve was located at the level of the carpal tunnel inlet in 11 patients, and the volar dislocated fragment of the lunate was located proximally adjacent to the floor of the carpal tunnel inlet. This disorder is most prevalent in elderly women, and even advanced Kienböck disease can present without wrist pain. Our findings suggest that palmar protrusion of the lunate may be the primary cause of carpal tunnel syndrome associated with Kienböck disease.
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Síndrome do Túnel Carpal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Osso Semilunar , Masculino , Nervo Mediano , Pessoa de Meia-Idade , Osteonecrose , Estudos Retrospectivos , PunhoRESUMO
BACKGROUND: To evaluate the mid- to long-term clinical and radiographic outcomes after surgical treatment of chronic anterior dislocation of the radial head in children. METHODS: Open reduction was performed in 16 children (mean age, 9.3 years [range, 2.6-13.6 years]) with chronic anterior dislocation of the radial head. Twelve patients had a history of preceding injuries, with a mean interval between injury and surgery of 24 months (range, 2-86 months); 4 patients did not have injuries. Eight patients who had undergone reduction within 16 months were treated by open reduction and ulnar osteotomy. The other 8 patients who had not sustained trauma or had been injured >2 years previously required either annular ligament reconstruction or radial shortening in addition to ulnar osteotomy. RESULTS: The average preoperative Kim's elbow performance score was 77.2 ± 10.5, which significantly improved to 97.5 ± 5.8 at the final follow-up. The radial head was maintained in a reduced position in 14 patients and was subluxed in 2. Slight osteoarthritic changes of the elbow were observed in 2 patients with good reduction. The functional results were excellent in 15 and were good in 1 patient with an average follow-up of 6.5 years (range, 2.6-15.1 years). CONCLUSIONS: Our surgical procedure provided good mid- to long-term clinical and radiographic outcomes.
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Lesões no Cotovelo , Luxações Articulares/cirurgia , Osteotomia/métodos , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular/fisiologia , Adolescente , Criança , Pré-Escolar , Doença Crônica , Estudos de Coortes , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Procedimentos Ortopédicos/métodos , Medição da Dor , Rádio (Anatomia)/diagnóstico por imagem , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento , Ulna/cirurgiaRESUMO
BACKGROUND: Ulnar styloid fractures are often associated with distal radius fractures. However, controversy exists regarding whether to treat ulnar styloid fractures. This study aimed to evaluate clinical effects of internal fixation for ulnar styloid fractures after distal radius fractures were treated with the volar locking plate system. METHODS: We used prospectively collected data of distal radius fractures. 111 patients were enrolled in this study. A matched case-control study design was used. We selected patients who underwent fixation for ulnar styloid fractures (case group). Three control patients for each patient of the case group were matched on the basis of age, sex, and fracture type of distal radius fractures from among patients who did not undergo fixation for ulnar styloid fractures (control group). The case group included 16 patients (7 men, 9 women; mean age: 52.6 years; classification of ulnar styloid fractures: center, 3; base, 11; and proximal, 2). The control group included 48 patients (15 men, 33 women; mean age: 61.1 years; classification of ulnar styloid fractures: center, 10; base, 31; and proximal, 7). For radiographic examination, the volar tilt angle, radial inclination angle, and ulnar variance length were measured, and the union of ulnar styloid fractures was judged. For clinical examination, the range of motions, grip strength, Hand20 score, and Numeric Rating Scale score were evaluated. RESULTS: There was little correction loss for each radiological parameter of fracture reduction, and these parameters were not significantly different between the groups. The bone-healing rate of ulnar styloid fractures was significantly higher in the case group than in the control group, but the clinical results were not significantly different. CONCLUSIONS: We revealed that there was no need to fix ulnar styloid fractures when distal radius fractures were treated via open reduction and internal fixation with a volar locking plate system.
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Placas Ósseas , Fixação Interna de Fraturas/métodos , Traumatismo Múltiplo/cirurgia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular/fisiologia , Fraturas da Ulna/cirurgia , Adulto , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Traumatismo Múltiplo/diagnóstico por imagem , Medição da Dor , Estudos Prospectivos , Radiografia/métodos , Fraturas do Rádio/diagnóstico por imagem , Medição de Risco , Estatísticas não Paramétricas , Fraturas da Ulna/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Adulto JovemRESUMO
OBJECTIVE: The recovery function of somatosensory evoked magnetic fields (SEFs) was recorded to investigate excitatory and inhibitory balance in the somatosensory cortex of patients with carpal tunnel syndrome. METHODS: SEFs were recorded in patients and controls. Recordings were taken following median nerve stimulation with single and double pulses with interstimulus intervals of 10-200ms. The root mean square for the N20m component following the second stimulation was analyzed. SEFs following stimulation of the first and middle digits were also recorded and the location for the equivalent current dipoles was estimated in three-dimensional planes. RESULTS: Distances on the vertical axis between the equivalent current dipoles for the first and third digits were shorter in patients than in control participants. The root mean square for the N20m recovered earlier in patients compared to controls; this was statistically significant at an interstimulus interval of 10ms. There was no relationship between N20m recovery and the equivalent current dipole location in the primary somatosensory cortex. CONCLUSIONS: Carpal tunnel syndrome was associated with functional disinhibition and destruction of the somatotopic organization in the primary somatosensory cortex. SIGNIFICANCE: Disinhibitory changes might induce a maladaptation of the central nervous system relating to pain.
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Síndrome do Túnel Carpal/fisiopatologia , Potenciais Somatossensoriais Evocados/fisiologia , Nervo Mediano/fisiopatologia , Córtex Somatossensorial/fisiopatologia , Idoso , Mapeamento Encefálico , Estimulação Elétrica , Feminino , Humanos , Magnetoencefalografia , Masculino , Pessoa de Meia-Idade , Tempo de Reação/fisiologiaRESUMO
PURPOSE: We hypothesized that most patients with ulnar impaction syndrome have degenerative changes of the proximal lunotriquetral (LT) membrane and that ulnar-shortening osteotomy is an effective procedure in these patients. METHODS: We retrospectively reviewed 50 wrists of 49 patients with idiopathic ulnar impaction syndrome who underwent an arthroscopic evaluation at the time of ulnar-shortening osteotomy, and subsequently at plate removal. Based on the Geissler classification, patients were divided into group A, normal, and group B, grades I to IV. The degree of degeneration of the proximal LT membrane at first-look arthroscopy was compared with that at second-look arthroscopy. RESULTS: After ulnar-shortening osteotomy, both groups improved significantly in wrist range of motion and grip strength. According to the Mayo wrist score, 29, 18, and 3 patients showed excellent, good, and fair results, respectively. Of the 50 wrists, 25 had degenerative changes (group B) in the proximal LT membrane at the time of first-look arthroscopy. Of the 25 wrists in group B, 11 wrists improved based on the Geissler grade, 9 wrists showed no changes, and 2 wrists became worse. Clinically, patients demonstrated improvement after ulnar-shortening osteotomy regardless of the degree of degenerative LT ligament changes. CONCLUSIONS: Degenerative LT membrane changes that were seen in about half of our patients were mostly of a mild nature, and the clinical outcomes of ulnar-shortening osteotomy were acceptable. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Artropatias/cirurgia , Osteotomia/métodos , Ulna/cirurgia , Adolescente , Adulto , Idoso , Artralgia , Artroscopia , Feminino , Força da Mão , Humanos , Incidência , Artropatias/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ulna/patologia , Articulação do PunhoRESUMO
Surface-based bone hemangiomas are uncommon, mostly occurring in long bones of the lower extremities. Radiographic surface-based bone hemangioma images may present various features that provide a diagnostic challenge. We report a case of surface-based hemangioma of the radius that posed radiological diagnostic difficulties. The tumor size was small and the cortical reaction was subtle. MRI findings were nonspecific and angiography was useful in the assessment of painful but less obvious surface-based bone hemangioma. The patient's pain improved following surgery and no tumor recurrence was observed at 3 years after surgery.
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Neoplasias Ósseas/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Imageamento por Ressonância Magnética , Recidiva Local de Neoplasia/diagnóstico por imagem , Rádio (Anatomia)/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Feminino , Hemangioma/cirurgia , Humanos , Angiografia por Ressonância Magnética , Recidiva Local de Neoplasia/cirurgia , Osteotomia , Valor Preditivo dos Testes , Radiografia , Rádio (Anatomia)/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
Radial head dislocation associated with plastic bowing of the ulna is classified as a Monteggia equivalent lesion. This injury in children can be treated by closed reduction, but manipulative reduction may not completely correct plastic bowing of the ulna. We encountered two cases of incomplete reduction in which the radial head was reduced in a supination position, but redislocated during rotation from neutral to a pronation position. The patients were treated conservatively using an adjustable hinged elbow splint. Plain radiography at 6 weeks after incomplete closed reduction showed that the radial head was reduced in all positions from supination to pronation; thus, both patients had good outcomes. Our method is non-invasive and may be an option for treatment of incomplete reduction of radial head dislocation with acute plastic bowing of the ulna.
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Moldes Cirúrgicos , Articulação do Cotovelo/fisiopatologia , Fixação de Fratura/instrumentação , Luxações Articulares/terapia , Instabilidade Articular/terapia , Fratura de Monteggia/terapia , Rádio (Anatomia)/fisiopatologia , Contenções , Fenômenos Biomecânicos , Criança , Articulação do Cotovelo/diagnóstico por imagem , Desenho de Equipamento , Feminino , Fixação de Fratura/métodos , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/fisiopatologia , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Masculino , Fratura de Monteggia/diagnóstico por imagem , Fratura de Monteggia/fisiopatologia , Pronação , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Supinação , Fatores de Tempo , Resultado do TratamentoRESUMO
PURPOSE: To give a detailed clinical outcome analysis of a consecutive series of patients treated arthroscopically for traumatic triangular fibrocartilage complex (TFCC) foveal tears. METHODS: This study was a consecutive case series of 11 patients who underwent arthroscopically assisted repair for traumatic TFCC foveal lesions. The mean age at the time of surgery was 27 years. The mean follow-up was 30 months (range, 20-51 mo). All patients underwent arthroscopy-assisted foveal reattachment of the TFCC by means of a transosseous outside-in technique. The primary outcome measure was a self-administered upper limb disability questionnaire (Hand20 questionnaire) at the final follow-up. The Hand20 scores range from 0 to 100, with high scores indicating severe disability. Secondary outcome measures included pain, grip strength, range of motion, distal radioulnar joint (DRUJ) instability, and the Mayo Modified Wrist Score. We assessed postoperative complications for all patients. RESULTS: The mean preoperative Hand20 score was 29; it decreased significantly to 6 at final follow-up. Pain completely resolved in 7 patients, whereas mild pain during activity persisted in 4 patients. Grip strength improved significantly after surgery, from 84% to 98% of the unaffected side. Nine patients had no DRUJ instability and 2 had mild DRUJ instability at final follow-up. The Mayo Modified Wrist Score at final follow-up was 94 points; results were excellent in 7 patients, good in 3, and fair in 1. Skin irritation at the ulnar neck caused by the suture thread was recognized as a postoperative complication in 3 patients. CONCLUSIONS: Transosseous arthroscopic repair for traumatic TFCC foveal tear can restore stability to the DRUJ and provide satisfactory subjective and objective results without serious complications after more than 20 months' follow-up. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Artroscopia/métodos , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Avaliação da Deficiência , Feminino , Seguimentos , Força da Mão/fisiologia , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Masculino , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Fibrocartilagem Triangular/fisiopatologia , Traumatismos do Punho/fisiopatologiaRESUMO
PURPOSE: The lunate is classified into two types, one with a single distal facet and the other with two distal facets. The effect of lunate type on the incidence of wrist disease and trauma remains unclear. The purpose of this study is to evaluate a potential association between lunate morphology and wrist disorders. METHODS: We retrospectively reviewed the cases of 637 patients who had undergone wrist arthroscopy for wrist disorders. Patient charts and arthroscopic video images were reviewed retrospectively. We defined lunate type based on the Viegas classifications, according to its distal facet from a midcarpal arthroscopic image. Patient wrist disorders were divided into four groups: fractures and dislocations, Kienböck's disease, ulnar wrist pain, and degenerative disease. RESULTS: A Viegas type 1 lunate was observed in 349 wrists and a type 2 lunate in 288 wrists. Incidence of the type 2 lunate was different between the groups and was significantly lower for the Kienböck's disease and ulnar wrist pain groups than for the trauma and degenerative groups. CONCLUSIONS: The present study revealed a variable incidence of lunate type in wrist disorders. The proportion of type 2 lunates was lower in Kienböck's disease and ulnar wrist pain.
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Artroscopia/métodos , Artropatias/diagnóstico , Osso Semilunar/patologia , Articulação do Punho/cirurgia , Adulto , Estudos de Coortes , Feminino , Seguimentos , Humanos , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Medição da Dor , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Medição de Risco , Articulação do Punho/fisiopatologia , Adulto JovemRESUMO
PURPOSE: The Hand10 is a self-administered questionnaire for upper extremity disorders. This questionnaire consists of 10 short, easy-to-understand questions and explanatory illustrations. In the shortening and validation process, the Hand10 demonstrated high acceptability and reliability among elderly individuals, with the advantage of being compact. We hypothesized that attached illustrations may contribute to the ability to maintain the psychometric properties of a questionnaire and raise acceptability for the elderly. METHODS: A series of 106 elderly patients with upper extremity disorders, whose symptoms had been stable, completed the Hand10, the Japanese Society for Surgery of the Hand Version of Disability of the Arm, Shoulder and Hand, and the Revised Hasegawa's Dementia Scale. Participants were randomly allocated to receive either the illustrated Hand10 or the unillustrated Hand10. The potential advantages attributed to attached illustrations were investigated. RESULTS: No significant differences were found in baseline demographic data between subjects who received the illustrated and unillustrated questionnaires. The average percentage of items that the elderly patients left unanswered was 0.5 % for the illustrated Hand10 and 3.8 % for the unillustrated Hand10. Instrument test-retest reliability assessed with the intraclass correlation coefficient was 0.92 and 0.86, respectively. CONCLUSION: The use of explanatory illustrations attached to the Hand10 contributed to raise acceptability for elderly patients and were suggested to improve the reproducibility.
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Avaliação da Deficiência , Pessoas com Deficiência , Avaliação de Resultados da Assistência ao Paciente , Inquéritos e Questionários , Extremidade Superior/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Indicadores Básicos de Saúde , Humanos , Japão , Masculino , Doenças Musculoesqueléticas/terapia , Psicometria , Qualidade de Vida , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
A small, light, ball-joint device called PinFix, which can instantly convert a simple percutaneous cross pin fracture fixation system into a rigid external fracture fixation system based on truss structure, was developed. The purpose of this study was to compare the mechanical load and breaking strength of this truss-structure-based fixation system to that of the conventionally used external cantilever structure-based fixation system. Three types of mechanical loading tests, axial, bending, and torsion, were performed on an artificial fractured bone treated with either three-dimensional PinFix fixation, two-dimensional PinFix fixation, or conventional external fixation. The three- and two-dimensional PinFix fixations showed significantly more stiffness than conventional fixation on all three loading tests. Finite element analysis was next performed to calculate the stress distribution of the parts in PinFix and in the conventional fixator. The applied stress to the rod and connectors of PinFix was much less than that of the conventional external fixator. These results reflected the physical characteristic of truss structure in which applied load is converted to pure tension or compression forces along the members of the PinFix. In conclusion, PinFix is a simple fracture fixation system that has a truss-structure with a high rigidity.
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Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas Ósseas/cirurgia , Fenômenos Biomecânicos , Força Compressiva , Desenho de Equipamento , Análise de Elementos Finitos , Fixação de Fratura/métodos , Humanos , Teste de Materiais , Estresse MecânicoRESUMO
A prospective multicenter clinical study evaluated, using the Hand20 and hand diagram, the disability, incidence, location, and predictive factors of residual wrist pain 18 months after volar locking plate fixation of distal radius fracture in 122 patients. The average Hand20 score and numeric rating scores for pain were 13.1 +/- 18.2 and 2.1 +/- 23, respectively. Fifty-seven patients indicated that they had pain. Among those patients, 25 had ulnar pain and 45 had radial pain. The incidence of radial-sided wrist pain was higher than ulnar-sided wrist pain. Logistic regression analysis showed that female sex and intra-articular fracture significantly correlated with radial-sided wrist pain. Volar locking plate fixation maintained anatomical reduction; however, a significant number of patients complained of residual wrist pain.