Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 29
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Instr Course Lect ; 69: 317-330, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017735

RESUMO

Scaphoid fractures are common and notorious for their troublesome healing. The aim of this review is to reevaluate the current best evidence for the diagnosis, classification, and treatment of scaphoid fractures and nonunions. MRI and CT are used to establish a "definitive diagnosis" with comparable diagnostic accuracy although neither is 100% specific. Current classifications cannot reliably predict union or outcomes; hence, a descriptive analysis of fracture location, type, and extent of displacement remains most useful. Treatment of a nondisplaced scaphoid waist fracture remains an individualized decision based on shared decision-making. Open reduction and internal fixation may be preferred when fracture displacement exceeds 1 mm, and the fracture is irreducible by closed or percutaneous means. For unstable nonunions with carpal instability, either non-vascularized cancellous graft with stable internal fixation or corticocancellous wedge grafts will provide a high rate of union and restoration of carpal alignment. For nonunions characterized with osteonecrosis of the proximal pole, vascularized bone grafting can achieve a higher rate of union.


Assuntos
Fraturas não Consolidadas , Osso Escafoide , Traumatismos do Punho , Transplante Ósseo , Fixação Interna de Fraturas , Consolidação da Fratura , Humanos
2.
Curr Rev Musculoskelet Med ; : 369-378, 2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31230191

RESUMO

PURPOSE OF REVIEW: To provide an overview of emerging fixation constructs and materials used in the operative management of distal radius fractures. RECENT FINDINGS: The indications, advantages, and disadvantages of relatively new implants and devices used to treat distal radius fractures are discussed. These include the intramedullary nail, intramedullary cage, radiolucent volar locking plate, distal radius hemiarthroplasty, and bone graft substitutes. The spectrum of distal radius fracture patterns may make it impossible to depend on a single device for fixation, and surgeons managing distal radius fractures should be adept at using various surgical approaches, techniques, and hardware systems. Additional studies demonstrating the cost-effectiveness, biomechanical properties, and clinical outcomes will be useful in determining the utility of the described techniques.

3.
J Hand Surg Am ; 43(8): 772.e1-772.e7, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29503049

RESUMO

PURPOSE: To evaluate the survival and long-term outcomes of thumb metacarpal extension osteotomy for early carpometacarpal (CMC) arthritis. METHODS: Patients who underwent a thumb extension osteotomy between years 2000 and 2011 were identified. Patient demographics, complications, and reoperations were recorded. The Kaplan-Meier survival analysis was used with subsequent CMC surgery defined as failure. Patients who had undergone surgery 10 years or more before the study date underwent radiographic assessment, grip and pinch strength testing, and completed the Patient Rated Wrist/Hand Evaluation (PRWHE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires. RESULTS: Thirty-two procedures in 7 males and 21 females were performed (mean age, 44.8 y). There were no cases of nonunion. Nine of 32 thumbs developed pin site erythema and were treated with oral antibiotics. Two thumbs developed osteomyelitis. Seven of 32 thumbs (22%) required reoperation. The Kaplan-Meier analysis indicated a 70% probability that patients who have this procedure will not require additional CMC surgery up to 14 years. Seven patients with a mean follow-up of 12.3 years (minimum 10 y) returned for clinical evaluation. The mean PRWHE and QuickDASH scores were 32.1 and 27.7, respectively. Examination revealed 124% pinch and 98% grip strength relative to the preoperative values. One thumb did not progress from stage II disease; 2 thumbs progressed from stage I to stage II; 1 thumb progressed from stage II to stage III; 1 thumb progressed from stage II to stage IV; 1 thumb did not have disease progression at the CMC joint, but developed scaphotrapeziotrapezoidal arthritis. CONCLUSIONS: Although reoperation rates and superficial infections with the described method of fixation were relatively high, thumb metacarpal osteotomy provides some degree of pain relief and improvement of function. This procedure may have utility as a temporizing measure in younger patients as it does not compromise future reconstructive procedures. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Artrite/cirurgia , Articulações Carpometacarpais/cirurgia , Osteotomia/métodos , Polegar/cirurgia , Adulto , Artrite/diagnóstico por imagem , Artrite/fisiopatologia , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/fisiopatologia , Avaliação da Deficiência , Progressão da Doença , Eritema/etiologia , Eritema/terapia , Feminino , Seguimentos , Força da Mão/fisiologia , Humanos , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Osteomielite/etiologia , Osteomielite/terapia , Osteotomia/efeitos adversos , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Polegar/diagnóstico por imagem , Polegar/fisiopatologia , Adulto Jovem
4.
Curr Rev Musculoskelet Med ; 10(1): 1-9, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28188545

RESUMO

PURPOSE OF REVIEW: The purposes of this review are to discuss the diagnosis and management of mallet and jersey finger injuries in athletes and to highlight how treatment impacts return to play. RECENT FINDINGS: Mallet finger: although numerous non-operative and operative techniques have been described, there continues to be little consensus regarding the optimal procedure. Jersey finger: ultrasound appears to be a cost-effective imaging modality that may be useful for preoperative planning. Wide-awake surgery offers optimal intraoperative assessment of the tendon repair. Tendon repair with volar plate augmentation has been shown to improve the strength of the repair in the laboratory, and early clinical results are encouraging. Most mallet finger injuries will heal with non-operative treatment over a period of 8-12 weeks, even when treatment is delayed up to 3-4 months. An acute diagnosis of jersey finger requires surgical treatment and generally means 8-12 weeks of inability to compete in most contact sports.

5.
J Am Acad Orthop Surg ; 24(9): 625-33, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27454024

RESUMO

Enchondroma is the most common primary bone tumor of the hand. This benign, cartilaginous tumor often presents as a pathologic fracture. When hand enchondroma is suspected, less common conditions, such as multiple enchondromatosis syndromes and benign and malignant lesions, should be ruled out. Surgical management with curettage is the standard of care for symptomatic lesions. However, controversy surrounds the timing of surgery for pathologic fractures and the use of surgical adjuncts and postcurettage void management. Microscopically distinguishing hand enchondroma from low-grade hand chondrosarcoma is a diagnostic challenge for pathologists, but the primary surgical treatment for both conditions is curettage because the latter has a low metastatic potential. Postoperative complications are typically joint stiffness and soft-tissue[FIGURE DASH]related deformities, whereas recurrence and malignant degeneration of solitary lesions are much less common. Most patients return to full function after surgery.


Assuntos
Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Condroma/diagnóstico , Condroma/cirurgia , Neoplasias Ósseas/complicações , Condroma/complicações , Condrossarcoma/diagnóstico , Curetagem/métodos , Diagnóstico Diferencial , Encondromatose/diagnóstico , Fraturas Espontâneas/etiologia , Mãos/patologia , Humanos , Complicações Pós-Operatórias/etiologia
6.
Hand (N Y) ; 11(2): 232-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27390569

RESUMO

BACKGROUND: Arthroscopic trapeziectomy with suture button suspensionplasty (ATBS) is a relatively new surgical option for the treatment of thumb carpometacarpal (CMC) osteoarthritis. Although ATBS has many potential benefits over alternative surgical treatments for CMC arthritis, little data exist regarding its safety and complication rates. The purpose of this study was to demonstrate that ATBS is associated with a low risk of complications within 1 year of surgery. METHODS: A retrospective review of patients treated with ATBS by one senior hand surgeon over a span of 3 years was performed. RESULTS: A total of 153 cases of ATBS were performed in 136 patients. Ninety-seven cases involved arthroscopic hemitrapeziectomies, and 56 involved arthroscopic complete trapeziectomies. There were 44 males and 92 females with a mean age of 62. Thirty-eight percent of the cases were graded as Eaton stage IV, 46% stage III, and 14% stage II CMC arthritis, while 3 cases (2%) were performed as revisions. Mean follow-up duration was 58 weeks. Mean preoperative key pinch strength of the affected versus the unaffected side was 92% compared with 95% postoperatively. Revision surgery was performed in 9 out of 153 cases (<6%). Of those 9 cases, 5 had additional minor bony debridement with subsequent improvement in pain, 3 had the implant repositioned due to button prominence, and 1 patient presented with osteomyelitis of the first and second metacarpals that was successfully treated with button removal and an antibiotic regimen. CONCLUSIONS: ATBS is a safe, minimally invasive procedure for treatment of symptomatic stages II through IV thumb CMC arthritis.

7.
Anat Res Int ; 2015: 786508, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26640711

RESUMO

Objective. The purpose of this study is to describe the three-dimensional morphometry of the brachialis muscle at its distal attachment to the ulna. Methods. Fifty cadaveric elbows were dissected and the brachialis distal insertion was isolated on the ulna bone and probed with a three-dimensional digitizer, to create a three-dimensional model of the footprint. Measurements and analysis of each footprint shape were recorded and compared based on gender and size. Results. There was significant gender difference in the surface length (P= 0.002) and projected length (P= 0.001) of the brachialis footprint. The shapes of the footprint also differed among the specimens. Conclusion. The shape of the brachialis muscle insertion differed among all the specimens without significant variation in gender or sides. There was also a significant difference in muscle length between males and females with little difference in the width and surface area. Significance. The information obtained from this study is important for kinematic understanding and surgical procedures around the elbow joint as well as the understanding of the natural age related anatomy of the brachialis footprint morphology.

8.
Anat Res Int ; 2015: 426974, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26380112

RESUMO

Introduction. The purpose of this study is to describe the inner synovial membrane (SM) of the anterior elbow capsule, both qualitatively and quantitatively. Materials and Methods. Twenty-two cadaveric human elbows were dissected and the distal humerus and SM attachments were digitized using a digitizer. The transepicondylar line (TEL) was used as the primary descriptor of various landmarks. The distance between the medial epicondyle and medial SM edge, SM apex overlying the coronoid fossa, the central SM nadir, and the apex of the SM insertion overlying the radial fossa and distance from the lateral epicondyle to lateral SM edge along the TEL were measured and further analyzed. Gender and side-to-side statistical comparisons were calculated. Results. The mean age of the subjects was 80.4 years, with six male and five female cadavers. The SM had a distinctive double arched attachment overlying the radial and coronoid fossae. No gender-based or side-to-side quantitative differences were noted. In 18 out of 22 specimens (81.8%), an infolding extension of the SM was observed overlying the medial aspect of the trochlea. The SM did not coincide with the outer fibrous attachment in any specimen. Conclusion. The humeral footprint of the synovial membrane of the anterior elbow capsule is more complex and not as capacious as commonly understood from the current literature. The synovial membrane nadir between the two anterior fossae may help to explain and hence preempt technical difficulties, a reduction in working arthroscopic volume in inflammatory and posttraumatic pathologies. This knowledge should allow the surgeon to approach this aspect of the anterior elbow compartment space with the confidence that detachment of this synovial attachment, to create working space, does not equate to breaching the capsule. Alternatively, stripping the synovial attachment from the anterior humerus does not constitute an anterior capsular release.

9.
Hand (N Y) ; 10(3): 461-71, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26330779

RESUMO

BACKGROUND: Postcurettage void augmentation in the management of hand enchondroma is a debated practice. The objectives of this study are to present the outcomes of hand enchondroma treatment by curettage without void augmentation at the authors' institution and to systematically review the literature pertinent to this aspect of management. METHODS: Initially, a retrospective case series of patients treated for hand enchondroma at the authors' institution was conducted to assess postoperative complications and radiographic consolidation. All patients were treated by curettage without void augmentation. Next, a systematic review was conducted. Postcurettage void management was categorized into four groups: (1) curettage alone, (2) curettage followed by augmentation with cancellous autograft, (3) curettage followed by augmentation with bioactive and osteoconductive materials other than autograft, and (4) curettage followed by augmentation with bone cements. Complication and recurrence rates were compared. RESULTS: The authors' series was composed of 24 patients with 26 lesions. The mean age was 38.9 years (range 14-61), and the mean follow-up was 26 months (range 3-120). There was one recurrence but no postoperative fractures or nonunions. As for the systematic review, a total of 22 studies involving 591 patients and 609 lesions were assessed. Complications occurred at an incidence of 0.7 % following curettage alone, 3.5 % following autograft, 0 % following augmentation with bioactive/osteoconductive materials, and 2.0 % following cement augmentation. No statistical differences were noted for complication or recurrence rates. CONCLUSIONS: Simple curettage is an effective and inexpensive technique that does not lead to increased complication rates in the treatment of most hand enchondromas.

10.
Hand (N Y) ; 9(3): 315-21, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25191161

RESUMO

BACKGROUND: Scaphoid excision and four-corner arthrodesis (FCA) is an acceptable motion sparing procedure used to treat wrist arthritis. Recently, a locking dorsal circular plate composed of polyether-ether-ketone has been introduced (Xpode®; TriMed Inc.). The purpose of this study is to assess the efficacy of this specific plate design with regard to FCA. METHODS: A retrospective chart review of all patients who underwent FCA with an Xpode® between January 1, 2008 and December 31, 2012 was conducted. Patients were contacted and asked to return to clinic for clinical and radiographic follow-up. Patient demographics, range of motion, grip strength, and complications were collected from medical records. Patients completed a patient-rated wrist evaluation (PRWE). A paired t test was used to compare means, and p values <0.05 were considered statistically significant. RESULTS: Twenty-six procedures (24 patients) were identified. One patient required full wrist fusion following the initial procedure. Of the 25 remaining wrists, arthrodesis was successfully achieved in 20 (80 %). Eleven patients (13 wrists, 52 %) returned to clinic for an average follow-up of 28 months. Mean wrist extension improved from 30 to 47°, and flexion decreased from 33 to 23°. Average grip strength was 77 % of the uninjured side. The mean PRWE scores for pain and function were 19.7 and 17.1, respectively. Five patients underwent additional operations (two hardware removals, two contracture releases, and one distal radial ulnar joint arthroplasty). CONCLUSIONS: FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.

11.
J Hand Surg Am ; 39(9): 1734-8, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25085044

RESUMO

PURPOSE: To present our surgical technique and results for the treatment of posttraumatic arthritis of the little finger carpometacarpal (CMC) joint. METHODS: We performed a retrospective review of 3 patients who underwent our surgical technique. All patients had previously sustained intra-articular fractures of the base of the little finger metacarpal and presented with painful posttraumatic arthritis of the fifth metacarpal-hamate joint. Patients were treated with little finger CMC arthroplasty and extensor carpi ulnaris suspensionplasty. RESULTS: We observed the 3 patients in the office over a mean of 21 months and by telephone for a mean for 51 months postoperatively. They had improvements in wrist motion and grip strength. Finger motion remained stable. Pain and tenderness at the little finger CMC joint were eliminated. CONCLUSIONS: Our technique provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Artroplastia/métodos , Articulações Carpometacarpais/cirurgia , Traumatismos dos Dedos/complicações , Osteoartrite/etiologia , Osteoartrite/cirurgia , Idoso , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/lesões , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Manejo da Dor , Medição da Dor , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Tendões/cirurgia
12.
J Hand Surg Am ; 39(5): 852-60, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24630941

RESUMO

PURPOSE: Flexor pollicis longus (FPL) tendon rupture is a well-documented complication related to the use of distal radius volar locking plates (VLPs). The final common pathway of flexor tendon rupture appears to involve implants prominent at the watershed line. We hypothesized that significant differences in VLP prominence exist between various plate designs. METHODS: Ten fresh frozen specimens were dissected to identify the path of the FPL in relationship to the distal radius at the watershed line. Five VLP designs were fixed to each specimen based on their anatomic fit, and slid distally until the distal edge of the plate reached the watershed line. The position of each fixed plate was evaluated by fluoroscopy. We used a 3-dimensional laser scanner to create computer models. The total surface area of plate prominence volar to the watershed line and the prominent area beneath the FPL were measured in the axial plane using computer software. RESULTS: At the watershed line, the FPL was located at 54% of the maximal width of the radius, as measured from its volar-ulnar corner. There were no significant differences in the location of plate fixation on lateral view radiographs according to the classification of Soong et al. The mean total surface area of plate prominence was 36 mm(2). The mean prominent area beneath the FPL was 10 mm2. Significant differences in plate prominence were noted for various designs. CONCLUSIONS: Despite optimal plate placement, various VLP designs were observed to have prominent profiles volar to the watershed line, to varying extents. CLINICAL RELEVANCE: The results raise concerns regarding interference between all of the analyzed VLP designs and the FPL. This study may help guide both implant design considerations and assist the surgeon in better understanding implant morphology as it relates to iatrogenic flexor tendon injury.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Placa Palmar/lesões , Placa Palmar/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos dos Tendões/etiologia , Traumatismos dos Tendões/cirurgia , Cadáver , Humanos , Desenho de Prótese , Ruptura
13.
J Bone Joint Surg Am ; 96(3): e20, 2014 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-24500592

RESUMO

BACKGROUND: The aims of this study were to (1) estimate the prevalence of clinical depression and posttraumatic stress disorder (PTSD) one to two months (Time 1) and five to eight months (Time 2) after musculoskeletal trauma and (2) determine the cross-sectional and longitudinal relationship of psychological variables (depression, PTSD, catastrophic thinking, and pain anxiety) at Time 1 to musculoskeletal disability and pain intensity at Time 1 and Time 2, after accounting for injury characteristics and demographic variables. METHODS: Patients with one or more fractures that had been treated operatively completed measures of depression, PTSD, pain anxiety, catastrophic thinking, musculoskeletal disability (the Short Musculoskeletal Function Assessment [SMFA]), and pain (the Numerical Rating Scale) at rest and during activity at Time 1 (152 patients) and at Time 2 (136 patients). Additional explanatory variables included injury severity, use of opioid pain medication at Time 1, and multiple or single injuries. RESULTS: The screening criteria for an estimated diagnosis of clinical depression were met by thirty-five of the 152 patients at Time 1, and twenty-nine of the 136 patients at Time 2. Screening criteria for an estimated diagnosis of PTSD were met by forty-three of the 152 patients at Time 1 and twenty-five of the 136 patients at Time 2. Cross-sectional hierarchical linear regression models that included multiple injuries, scores of the Abbreviated Injury Scale, and self-reported opioid use explained between 24% and 29% of the variance in pain and disability, respectively, at Time 1. After the addition of psychological variables, the model explained between 49% and 55% of the variance. Catastrophic thinking (as measured with use of the Pain Catastrophizing Scale) at Time 1 was the sole significant predictor of pain at rest, pain during activity, and disability (as measured with use of the SMFA) at Time 2. CONCLUSIONS: We found that psychological factors that are responsive to cognitive behavioral therapy--catastrophic thinking, in particular--are strongly associated with pain intensity and disability in patients recovering from musculoskeletal trauma.


Assuntos
Transtorno Depressivo/etiologia , Pessoas com Deficiência/psicologia , Sistema Musculoesquelético/lesões , Transtornos de Estresse Pós-Traumáticos/etiologia , Adaptação Psicológica , Analgésicos Opioides/uso terapêutico , Ansiedade/etiologia , Catastrofização/prevenção & controle , Catastrofização/psicologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Medição da Dor , Ferimentos e Lesões/psicologia , Ferimentos e Lesões/cirurgia
14.
Orthop Clin North Am ; 44(4): 591-603, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24095074

RESUMO

Adult traumatic brachial plexus injury involves injury of the C5-T1 spinal nerves. Common patterns of injury include "upper arm" and "total arm" types. The specific signs of preganglionic avulsion injury infer a poor prognosis for spontaneous recovery and surgery may be needed. Detailed preoperative evaluation is recommended for localization of the lesions. The treatment of upper arm type injury comprises restoration of elbow flexion and shoulder control. Good functional results may be achieved after multiple nerve transfers. The treatment of total arm type includes hand function reconstruction, in addition to shoulder and elbow treatment. Current options for hand function reconstruction include functioning free muscle transfers and nerve transfers.


Assuntos
Plexo Braquial/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Adulto , Plexo Braquial/anatomia & histologia , Plexo Braquial/fisiologia , Humanos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia
15.
J Hand Surg Am ; 38(5): 976-982.e1, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23566725

RESUMO

PURPOSE: To present the outcomes after one-bone forearm (OBF) surgery for chronic posttraumatic forearm and distal radioulnar joint instability. METHODS: We conducted a retrospective chart review to study patients who underwent OBF surgery because of a traumatic etiology. We collected patient demographics, surgical technique, preoperative and postoperative range of motion, final grip strength, and complications from the medical records. Patients were asked to complete the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, a 0- to 10-point pain scale, and a 0- to 10-point treatment satisfaction scale. RESULTS: There were 5 male and 5 female patients, with a mean age of 32 years at the time of OBF surgery (range, 17-44 y). The mean number of procedures before OBF surgery was 3.6 (range, 2-7); 4 patients had undergone a Darrach procedure and 3 patients had undergone a Sauvé-Kapandji procedure. The median clinical follow-up duration was 6 years (range, 1-17 y). Wrist and elbow range of motion did not change remarkably before and after surgery. Of 8 primary OBF surgeries, 3 resulted in nonunion. Of 10 patients, 4 experienced painful impingement of the remaining proximal radius on adjacent bone and soft tissue and required a total of 7 procedures after OBF surgery. The median follow-up duration for patient-rated outcomes was 10 years (range, 5-21 y; n = 7). The median Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 77, the median pain score was 7, and the median satisfaction score was 7. CONCLUSIONS: In our experience, complications after OBF surgery are common. Although wrist and elbow range of motion were spared, pain persisted and functional outcomes were poor. One-bone forearm surgery is our last resort for a chronically painful and unstable forearm. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Articulação do Cotovelo/cirurgia , Instabilidade Articular/cirurgia , Osteotomia , Rádio (Anatomia)/cirurgia , Ulna/cirurgia , Articulação do Punho/cirurgia , Adolescente , Adulto , Doença Crônica , Articulação do Cotovelo/diagnóstico por imagem , Feminino , Força da Mão , Humanos , Masculino , Osteotomia/efeitos adversos , Medição da Dor , Satisfação do Paciente , Radiografia , Amplitude de Movimento Articular , Articulação do Punho/diagnóstico por imagem , Adulto Jovem
16.
J Hand Surg Am ; 38(4): 684-9, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23474162

RESUMO

PURPOSE: To determine the effect of a specific orthotic intervention and therapy protocol on proximal interphalangeal (PIP) joint contractures of greater than 40° caused by Dupuytren disease and treated with collagenase injections. METHODS: All patients with PIP joints contracted at least 40° by Dupuytren disease were prospectively invited to participate in the study. Following standard collagenase injection and cord rupture by a hand surgeon, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol that consisted of orthotic intervention to address residual PIP joint contracture. In addition, exercises were initiated emphasizing reverse blocking for PIP joint extension and distal interphalangeal joint flexion exercises with the PIP joint held in extension to lengthen a frequently shortened oblique retinacular ligament. Patients were assessed before injection, immediately after injection, and 1 and 4 weeks later. There were 22 fingers in 21 patients. The mean age at treatment was 63 years (range, 37-80 y). RESULTS: The mean baseline passive PIP joint contracture was 56° (range, 40° to 80°). At cord rupture, the mean PIP joint contracture became 22° (range, 0° to 55°). One week after cord rupture and therapy, the contracture decreased further to a mean of 12° (range, 0° to 36°). By 4 weeks, the mean contracture was 7° (range, 0° to 35°). The differences in PIP joint contracture were statistically significant at all time points except when comparing the means at 1 week and 4 weeks. The results represent an 88% improvement of the PIP joint contracture. CONCLUSIONS: In the short term, it appears that severe PIP joint contractures benefit from specific, postinjection orthotic intervention and targeted exercises. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Colagenases/uso terapêutico , Contratura de Dupuytren/diagnóstico , Contratura de Dupuytren/terapia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos de Coortes , Feminino , Seguimentos , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Recidiva , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Hand (N Y) ; 8(3): 261-6, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24426932

RESUMO

BACKGROUND: This study examined the efficacy, complications, and contracture recurrence in patients who received injectable collagenase clostridium histolyticum (CCH) for Dupuytren's-induced metacarpophalangeal (MP) and proximal interphalangeal (PIP) joint contractures. METHODS: A retrospective chart review at one center compared the degree of MP and PIP joint contracture pre-injection, post-cord rupture, and at final follow-up after a minimum duration of 6 months. Recurrence was defined as a 20 ° or greater increase in contracture above the minimum value achieved. RESULTS: Of 102 eligible patients, 48 patients (47 %) (31 males, 17 females) were available for review. 53 digits and 64 joints (46 MP joints and 18 PIP joints) were studied. The mean patient age was 66 years (range, 48-87 years) and mean follow-up duration was 15 months (range, 6 to 25 months). The mean MP joint contracture was 51 ± 20 ° at baseline, 4 ± 8 ° post-cord rupture, and 9 ± 15 ° at latest follow-up. The mean PIP joint contracture was 39 ± 23 ° at baseline, 14 ± 14 ° at cord rupture, and 29 ± 20 ° at latest follow-up. Of the 46 MP joints and 18 PIP joints, 11 MP (24 %) and 7 (39 %) PIP joints met the recurrence criteria. Of 102 patients, 1 patient had a small finger flexor tendon rupture. CONCLUSIONS: Despite the dramatic initial reduction in contracture, recurrence developed in a high proportion of patients over the study period. While initially effective, CCH may not provide durable contracture reduction. However, CCH remains a viable nonsurgical treatment for Dupuytren's disease.

18.
Hand (N Y) ; 8(3): 291-5, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24426936

RESUMO

BACKGROUND: We hypothesize that one-stage Integra skin coverage is an effective treatment modality for the treatment of fingertip defects. METHODS: Nine patients who sustained fingertip injuries were treated with one-stage Integra coverage. In all cases, Integra was placed directly on bone. Static two-point discrimination and the Semmes-Weinstein Monofilament Test (SWMFT) were used to determine the sensations of the affected and opposite unaffected digit. The QuickDASH, Cold Intolerance Symptom Severity (CISS), visual analog scale (VAS), and a 0-10-point pain scale were administered to assess patient function, satisfaction, and pain levels. RESULTS: The mean age was 53.1 years (39-61). There were 8 males and 1 female. The average area covered was 2.3 cm(2) (1.0-3.2). The mean follow-up duration was 16 months (8-46). The median QuickDASH, CISS score, VAS patient satisfaction, and 0-10 pain score were 9.1 (2.3-40.9), 18 (4-30), 10 (most satisfied) (7-10), and 0 (0-3), respectively. Five patients were evaluated for their digital sensory perception. The mean static two-point discrimination was 9.6 mm for the affected digit and 4.6 mm for the opposite unaffected digit. The median SWMFT was 4.31 for the affected digit and 3.61 for the opposite unaffected digit. CONCLUSION: For small soft tissue and bone defects involving the fingertip, the use of Integra without further skin grafting appears to be effective, avoids the morbidity of the donor site, and avoids a second surgery. Despite mild sensory deficits, patients were satisfied with the results and fully functional during short-term follow-up.

19.
Hand (N Y) ; 8(3): 302-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24426938

RESUMO

BACKGROUND: Baseball players are susceptible to a number of specific upper extremity injuries secondary to batting, pitching, or fielding. Fractures of the hook of hamate have been known to occur in batters. The purpose of this study is to present our experience with the surgical management of hook of hamate fractures and their short-term impact on the playing capability of competitive baseball players. METHODS: A retrospective chart review was performed on patients with hook of hamate fractures between the years 2000 and 2012. The inclusion criteria were (1) hook of hamate fracture, (2) competitive baseball players, and (3) surgical treatment of the injury. Patient demographics, mechanism of injury, surgical treatment, and outcome were collected from the medical records. Information on return to play was collected from the Internet when applicable. RESULTS: There were seven male patients that underwent eight procedures. The mechanism of injury was attributed to batting in six cases and rogue pitches in two cases. All surgeries consisted of hamate hook excision and ulnar tunnel decompression. One patient had concomitant carpal tunnel release. The median time between surgery and return to play was 5.7 weeks (range, 4.3 to 10.4 weeks). CONCLUSIONS: The mechanism of hook of hamate fractures in baseball players is predictable, most often developing secondary to repetitive swinging. This injury may occur at all levels of competition. Ulnar tunnel decompression with hook of hamate excision provides good outcomes, with minimal complications and early return to play.

20.
Hand (N Y) ; 8(4): 479-82, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24426971

RESUMO

One-bone forearm surgery is generally regarded as one of the last available salvage procedures that could be used to treat patients with longitudinal forearm instability secondary to a congenital, oncologic, or a post-traumatic etiology. We performed this procedure on a 23-year-old patient with longitudinal forearm instability secondary to Hajdu-Cheney syndrome, which is a rare genetic disorder characterized by generalized ligamentous laxity, skeletal dysplasia, acro-osteolysis, and generalized osteoporosis. The patient developed shoulder pain secondary to overuse 28 months following treatment, and was managed conservatively. Eight years after surgery, the patient had not undergone any additional procedures, had no pain, reported a Quick Disabilities of the Arm Shoulder and Hand score of 21, and was completely satisfied with treatment. Although OBF procedure is a radical first-line salvage option, in unique circumstances and appropriate patient selection, it may provide acceptable, durable, and predictable results.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA