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1.
Plast Reconstr Surg ; 145(4): 969-976, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32221216

RESUMO

BACKGROUND: This study assessed the risk and factors of complications after volar locking plate fixation of distal radius fractures. METHODS: A single-institution retrospective review of patients undergoing volar locking plate fixation of distal radius fractures between May of 2000 and May of 2015 was undertaken. Demographic data, major complications, minor complications, and radiographic parameters were evaluated. RESULTS: Six hundred forty-seven distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean body mass index was 28.0, and 14.6 percent of patients had a body mass index greater than 35. Fractures were classified as Arbeitsgemeinschaft für Osteosynthesefragen class 23-C (67.2 percent), 23-A (26.6 percent), and 23-B (6.2 percent). The incidence of major and minor complications was 13.8 percent and 17.5 percent, respectively. The most common complication was transient paresthesia (9.7 percent). The incidence of tendon rupture or irritation was 0.5 percent or 2.5 percent, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2 percent at an average of 427.8 days after surgery. Major complications and minor complications were increased 2.2- and 1.9-fold, respectively, in patients with a body mass index greater than 35. Major complications were also increased 3.19 times in patients with residual intraarticular step-off. Hardware removal was 3.3 times more likely in patients with Soong grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes mellitus. CONCLUSIONS: Volar plate osteosynthesis of distal radius fractures is associated with an overall low complication rate. Patient factors, including diabetes mellitus and obesity, and intraoperative factors, including intraarticular fracture alignment and plate prominence, were associated with a higher rate of complications or revision surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32097249

RESUMO

Giant cell tumor of the distal radius is a rare, locally destructive, and frequently recurrent tumor. We present a case of Campanacci Grade III giant cell tumor of the distal radius with pathologic fracture and cortical destruction which was treated with neoadjuvant denosumab. This facilitated en-bloc resection of the entire distal radius, including the articular surface, while minimizing tumor contamination. Reconstruction was accomplished using a vascularized ulnar transposition flap to facilitate radioulnoscapholunate fusion, which was fixated using a long-stem contralateral variable angle locking volar distal radius plate in a dorsal position. This case illustrates multidisciplinary management of a challenging reconstructive problem and demonstrates a novel strategy for fixation which repurposes familiar and readily available hardware to provide optimal osteosynthesis.

3.
Plast Reconstr Surg ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31929453

RESUMO

BACKGROUND: To assess the risk and factors of complications after volar locking plate fixation of distal radius fractures (VLPDR). METHODS: A single institution retrospective review of patients undergoing VLPDR between May 2000-May 2015 was undertaken. Demographic data, major complications, minor complications and radiographic parameters were evaluated. RESULTS: 647 distal radius fractures managed with volar plate fixation in 636 patients were reviewed. Mean follow-up was 9.1 months. Mean age was 56.5 years. Mean BMI was 28.0 and 14.6% of patients had a BMI greater than 35. Fractures were classified as AO class 23-C(67.2%), 23-A(26.6%) and 23-B(6.2%). The incidence of major and minor complications was 13.8% and 17.5%, respectively. The most common complication was transient paresthesia(9.7%). The incidence of tendon rupture or irritation was 0.5% or 2.5%, respectively. Hardware removal for painful/symptomatic hardware occurred in 6.2% at an average of 427.8 days post-surgery. Major complications and minor complications were increased 2.2 and 1.9 fold in patients with a BMI>35. Major complications were also increased 3.19 times in patients with residual intra-articular step off. Hardware removal was 3.3 times more likely in patients with Soong Grade 2 plate prominence and 2.9 times more likely in patients with a history of diabetes. CONCLUSIONS: Volar plate osteosynthesis of distal radius fractures is associated with an overall low-complication rate. Patient factors including diabetes and obesity as well as intra-operative factors including intra-articular fracture alignment and plate prominence were associated with a higher rate of complications or revision surgery.

4.
Nanomedicine (Lond) ; 14(20): 2659-2677, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31612779

RESUMO

Surgical intervention followed by physical therapy remains the major way to repair damaged nerves and restore function. Imaging constitutes promising, yet underutilized, approaches to improve surgical and postoperative techniques. Dedicated methods for imaging nerve regeneration will potentially provide surgical guidance, enable recovery monitoring and postrepair intervention, elucidate failure mechanisms and optimize preclinical procedures. Herein, we present an outline of promising innovations in imaging-based tracking of in vivo peripheral nerve regeneration. We emphasize optical imaging because of its cost, versatility, relatively low toxicity and sensitivity. We discuss the use of targeted probes and contrast agents (small molecules and nanoparticles) to facilitate nerve regeneration imaging and the engineering of grafts that could be used to track nerve repair. We also discuss how new imaging methods might overcome the most significant challenges in nerve injury treatment.

5.
J Bone Joint Surg Am ; 101(16): e80, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436660

RESUMO

BACKGROUND: Traumatic brachial plexus injuries (BPIs) disproportionately affect young, able-bodied individuals. Beyond direct costs associated with medical treatment, there are far-reaching indirect costs related to disability and lost productivity. Our objective was to estimate per-patient indirect cost associated with BPI. METHODS: We estimated indirect costs as the sum of (1) short-term wage loss, (2) long-term wage loss, and (3) disability payments. Short-term (6-month) wage loss was the product of missed work days and the average earnings per day. The probability of return to work was derived from a systematic review of the literature, and long-term wage loss and disability payments were estimated. Monte Carlo simulation was used to perform a sensitivity analysis of long-term wage loss by varying age, sex, and return to work simultaneously. Disability benefits were estimated from U.S. Social Security Administration data. All cost estimates are in 2018 U.S. dollars. RESULTS: A systematic review of the literature demonstrated that the patients with BPI had a mean age of 26.4 years, 90.5% were male, and manual labor was the most represented occupation. On the basis on these demographics, our base case was a 26-year-old American man working as a manual laborer prior to BPI, with an annual wage of $36,590. Monte Carlo simulation estimated a short-term wage loss of $22,740, a long-term wage loss of $737,551, and disability benefits of $353,671. The mean total indirect cost of traumatic BPI in the Monte Carlo simulations was $1,113,962 per patient over the post-injury lifetime (median: $801,723, interquartile range: $22,740 to $2,350,979). If the probability of the patient returning to work at a different, lower-paying job was doubled, the per-patient total indirect cost was $867,987. CONCLUSIONS: BPI can have a far-reaching economic impact on both individuals and society. If surgical reconstruction enables patients with a BPI to return to work, the indirect cost of this injury decreases. LEVEL OF EVIDENCE: Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Plexo Braquial/lesões , Efeitos Psicossociais da Doença , Avaliação da Deficiência , Traumatismos dos Nervos Periféricos/economia , Traumatismos dos Nervos Periféricos/terapia , Ferimentos e Lesões/complicações , Adulto , Neuropatias do Plexo Braquial/economia , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/terapia , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Traumatismos dos Nervos Periféricos/diagnóstico , Retorno ao Trabalho/economia , Estados Unidos , Adulto Jovem
6.
J Hand Surg Am ; 44(8): 662-668.e1, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31078338

RESUMO

PURPOSE: We hypothesized that patients with preoperative opioid prescriptions and diagnoses of depression and anxiety would be at increased risk for prolonged opioid prescriptions after surgery for brachial plexus injury (BPI). METHODS: Using an administrative database of privately insured patients, we assembled a cohort of BPI surgery patients and a control group of non-BPI patients, matching for age, sex, and year. Pharmacy claims for prescriptions filled for opioids and neuropathic pain medications were examined 12 months before surgery to 180 days after surgery. The primary outcome was prolonged opioid prescription, defined as receiving a prescription 90 to 180 days after the index (BPI surgery or randomly selected date of service for controls). Multivariable regression was used to examine risk factors for postoperative opioid use, including diagnoses of depression, anxiety, drug abuse, tobacco use, and preoperative use of opioids and neuropathic pain medications. A subgroup analysis was performed for opioid-naive BPI patients between 30 days to 1 year before surgery. RESULTS: Among BPI surgery patients (n = 1,936), 27.7% had prolonged opioid prescriptions. Among opioid-naive BPI patients (n = 911), 10.8% had prolonged opioid prescriptions. In controls (n = 19,360), frequency of prolonged opioid prescriptions was 0.11%. Among all BPI patients, after adjustment for age and sex, predictors of prolonged postoperative opioid prescriptions in BPI patients were preoperative opioids, preoperative neuropathic pain medication use, histories of drug abuse, tobacco use, and anxiety. CONCLUSIONS: Prolonged postoperative opioids prescriptions after BPI reconstruction are higher than previous estimates among other surgical patients. In addition to establishing normative data among this population, our findings serve to increase awareness of risk factors for prolonged opioids after BPI reconstruction and encourage coordinated multidisciplinary care. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

7.
JBJS Rev ; 7(5): e1, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31082935
8.
Hand (N Y) ; 14(4): 547-553, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-29322875

RESUMO

Background: This study compares the effectiveness of a peripheral capsular repair with a knotless arthroscopic transosseous ulnar tunnel repair (TR) in restoring distal radioulnar joint (DRUJ) stability and stiffness in the setting of a massive triangular fibrocartilage complex (TFCC) tear. Methods: Eight matched pairs of fresh-frozen cadaveric forearms were tested. Each forearm was tested in supination and pronation using 3-dimensional (3D) optical tracking devices prior to any intervention. Each specimen then underwent a diagnostic wrist arthroscopy and sectioning of the TFCC's deep and superficial fibers. All specimens were then retested to assess instability secondary to the tear. The TFCC was repaired with either a peripheral capsular repair (CR) using three 2-0 polydioxanone sutures or a transosseous ulnar TR using a 2-0 FiberWire, and then retested (statistical significance; P < .05). Results: After TFCC arthroscopic sectioning, all specimens were unstable with a significant increase in translation and a significant decrease in stiffness. TFCC repair with TR resulted in displacement and stiffness similar to the native tissue. CR specimens were found to have significantly greater displacement and significantly decreased stiffness compared with the intact state. Conclusions: Arthroscopic sectioning of the TFCC resulted in DRUJ instability, as measured by stiffness and ulnar translation. TR effectively restored DRUJ stability and demonstrated no significant difference in postoperative stiffness or maximal displacement when compared with the intact specimen in pronation and supination. This study provides biomechanical evidence that an arthroscopic ulnar tunnel technique can restore stability to the DRUJ after a massive TFCC tear.

9.
Hand (N Y) ; 14(1): 34-41, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30295084

RESUMO

BACKGROUND: Birth brachial plexus injury usually affects the upper trunks of the brachial plexus and can cause substantial loss of active shoulder external rotation and abduction. Due to the unbalanced rotational forces acting at the glenohumeral joint, the natural history of the condition involves progressive glenohumeral joint dysplasia with associated upper limb dysfunction. Surgical reconstruction methods have been described previously by Sever and L'Episcopo, and modified by Hoffer and Roper to release the adduction contracture and to restore external rotation and shoulder abduction. METHODS: The authors describe their preferred technique for contracture release and tendon transfer to improve external rotation and shoulder abduction. Pertinent anatomy and highlights of surgical exposure are reviewed. RESULTS: The senior author has utilized this technique with consistent clinical outcomes to improve shoulder function for patients with persisting nerve palsy associated with birth brachial plexus injury. A review of the literature supports utilization of this technique. CONCLUSIONS: Transfer of the latissimus dorsi and teres major to the posterior rotator cuff for reanimation of shoulder abduction and external rotation deficits associated with birth brachial plexus injury is a safe and reliable technique. Careful patient selection and attention to surgical detail are critical for optimal outcomes.


Assuntos
Traumatismos do Nascimento/fisiopatologia , Neuropatias do Plexo Braquial/cirurgia , Plexo Braquial/lesões , Liberação da Cápsula Articular/métodos , Articulação do Ombro/cirurgia , Transferência Tendinosa/métodos , Pontos de Referência Anatômicos , Axila/anatomia & histologia , Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/fisiopatologia , Contraindicações de Procedimentos , Humanos , Músculo Esquelético/anatomia & histologia , Cuidados Pós-Operatórios , Amplitude de Movimento Articular/fisiologia , Rotação , Articulação do Ombro/fisiopatologia , Tenotomia
10.
J Hand Surg Am ; 44(6): 523.e1-523.e5, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30287101

RESUMO

The branch of the anterior interosseous nerve to the pronator quadratus (PQ) is increasingly used as a donor nerve for end-to-end and reverse end-to-side nerve transfers. The anatomy of the PQ (and its nerve branch) is generally considered reliable in the absence of prior trauma. In this report, we describe a patient with an absent PQ despite intact clinical examination of other muscles supplied by the anterior interosseous nerve. The absence of the PQ precluded the use of its nerve as a donor nerve for transfer.

11.
Conf Proc IEEE Eng Med Biol Soc ; 2018: 3874-3877, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30441208

RESUMO

Measurement of finger active range of motion (ARoM) is essential to quantify outcomes accurately after hand surgery and during rehabilitation. Currently, finger ARoM is measured by a hand-held goniometer, which introduces measurement error. Moreover, this method is time-consuming. To speed up and simplify this process, we developed a system to measure the ARoM automatically. However, to assess the ARoM for all joints, different hand poses are required. The goal, then, is to design a classifier that achieves accurate and automatic discovery of the hand pose. According to the detected pose, the system will apply the appropriate algorithm to measure the ARoM for all fingers. Furthermore, this will enable a camera capture control system to provide the best view by moving the camera as required by each algorithm. A critical part of the system is the classifier because it controls the accuracy and compute time of the measurement. In this paper, we describe a study of different classifiers for hand pose and include results. The best classifier achieves 99% accuracy in classifying 400 test samples from five previously unseen human subjects with a compute time of 8ms per sample.


Assuntos
Mãos , Algoritmos , Dedos , Humanos , Rede Nervosa , Amplitude de Movimento Articular
12.
J Hand Surg Am ; 43(4): 360-367, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29482956

RESUMO

The physiological limitations of neural regeneration make peripheral nerve surgery challenging to both the surgeon and the patient. Presence of nerve gaps and local wound factors may all influence outcome, suggesting that barriers to reduce perineural scarring, minimize fibrosis, and avoid ischemia would be beneficial. To examine the evidence supporting their use, we reviewed the autologous and commercially-available options for barriers against scarring around a nerve. Numerous clinical case series demonstrated the effectiveness and safety of local/rotational flaps and autologous vein wrapping when used in the presence of recurrent compressive neuropathy. Translational research in animal models supports the biocompatibility of commercially available nerve wraps following nerve repair. To date, there are no reports of clinical use of commercially available nerve wraps in acute nerve repair, but a growing number of case series demonstrate their effectiveness and safety in chronic compressive neuropathy. Limited clinical evidence exists to support the efficacy of vein or flap coverage in acute nerve repairs.


Assuntos
Cicatriz/prevenção & controle , Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos , Nervos Periféricos/cirurgia , Âmnio/transplante , Animais , Colágeno/administração & dosagem , Matriz Extracelular/transplante , Humanos , Ácido Hialurônico , Mucosa Intestinal/transplante , Membranas Artificiais , Músculo Esquelético/transplante , Transplante Autólogo , Transplante Heterólogo , Veias/transplante
13.
J Hand Surg Am ; 43(1): 90.e1-90.e5, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29301716

RESUMO

Snapping triceps syndrome is a rarely diagnosed condition that can present with symptoms of ulnar neuritis or as an isolated problem itself. First described in 1970, this syndrome is minimally present in the literature with a few mechanistic studies, anatomical studies, radiological reports, and occasional case reports or series. In this article, we briefly review the literature, discuss potential causes and typical presentations of snapping triceps syndrome, and describe our operative technique. We also provide a representative case with intraoperative videos that illustrate the pathology and surgical treatment.


Assuntos
Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Descompressão Cirúrgica , Humanos , Procedimentos Ortopédicos , Cuidados Pós-Operatórios , Síndrome , Nervo Ulnar/cirurgia
14.
J Wrist Surg ; 6(3): 188-193, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28725499

RESUMO

Purpose In the surgical treatment of thumb carpometacarpal (CMC) joint arthritis, the effect of mild preoperative metacarpophalangeal (MCP) hyperextension on postoperative functional outcomes is unknown. We sought to examine outcomes after surgical treatment of CMC arthritis in patients with and without mild preexisting MCP deformity. Methods A retrospective review was conducted to analyze the functional outcomes of patients treated for CMC arthritis at a single institution from March 1998 to May 2009. All patients were treated with one of two standard CMC arthroplasty procedures-either ligament reconstruction tendon interposition (LRTI) or a Weilby procedure-and none had additional procedures to address MCP hyperextension. Pre- and postoperative assessments included pinch and grip strength, degree of MCP hyperextension, and thumb radial and palmar abduction. A t -test was used to assume unequal variances. Results A total of 203 patients were followed for an average of 27.3 months. Patients were divided into two groups: (1) patients without preoperative MCP hyperextension (167 patients) and (2) patients with mild but untreated preoperative MCP hyperextension (≤ 30 degrees; 36 patients). All patients underwent either a Weilby procedure (118 patients) or an LRTI; 85 patients). The main difference between techniques was the use of the abductor pollicis longus tendon as a post to secure the flexor carpi radialis (Weilby) or the use of a bone tunnel in the first metacarpal (LRTI). Analysis of the preoperative data showed no difference in the baseline parameters among both the groups, with the exception of MCP hyperextension. Postoperatively, neither the type of CMC procedure nor the presence of MCP hyperextension demonstrated any significant differences in key pinch, tip pinch, grip strength, and radial or palmar abduction of the thumb between the groups. Conclusion There were no statistically significant differences in improvement of functional outcomes after surgery when comparing patients without preoperative MCP hyperextension to patients with untreated MCP hyperextension of less than 30 degrees. Level of Evidence Level III, retrospective comparative study.

15.
Global Health ; 12: 8, 2016 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-27000847

RESUMO

Over the past year, two major policy initiatives have been introduced focusing on stimulating antibiotic development for human consumption. The European Investment Bank has announced the development of the Infectious Disease Financing Facility (IDFF) and the British government commissioned the Review on Antimicrobial Resistance, led by Jim O'Neill. Each constitutes a major effort by the European community to address the evolving crisis of antimicrobial resistance. Though both have similar goals, the approaches are unique and worthy of consideration.This manuscript utilizes a previously published framework for evaluation of antibiotic incentive plans to clearly identify the strengths and weaknesses of each proposal. The merits of each proposal are evaluated in how they satisfy four key objectives: 1) Improve the overall net present value (NPV) for new antibiotic projects; 2) Enable greater participation of Small to Medium Sized Enterprises (SME); 3) Encourage participation by large pharmaceutical companies; 4) Facilitate cooperation and synergy across the antibiotic market. The IDFF seeks to make forgivable loans to corporations with promising compounds, while the O'Neill group proposes a more comprehensive framework of early stage funding, along with the creation of a stable global market.Ultimately, the proposals may prove complementary and if implemented together may form a more comprehensive plan to address an impending global crisis. Substantial progress will only be made on these efforts if action is taken at an international level, therefore we recommend consideration of these efforts at the upcoming G20 summit.


Assuntos
Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Financiamento de Capital/métodos , Controle de Doenças Transmissíveis/métodos , Doenças Transmissíveis/tratamento farmacológico , Resistência Microbiana a Medicamentos/efeitos dos fármacos , Humanos , Cooperação Internacional , Saúde Pública/métodos
16.
J Wrist Surg ; 5(1): 52-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26855837

RESUMO

Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant correlations between sigmoid notch step-off, diastasis or DRUJ subluxation and either KL grade of arthritis or DASH scores. Conclusion Fractures involving the sigmoid notch did not appear to have a greater prevalence of DRUJ posttraumatic arthritis in operatively treated patients at greater than 6 years of follow-up. Postoperative sigmoid notch step-off, diastasis or DRUJ subluxation had a minimal effect on upper extremity function, but fractures with a coronal step-off of > 1.0-mm exhibited higher levels of upper extremity dysfunction. Level of Evidence Prognostic, Level III-Case control.

17.
Soc Sci Med ; 151: 167-72, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26808335

RESUMO

Over the past decade, there has been a growing recognition of the increasing growth of antibiotic resistant bacteria and a relative decline in the production of novel antibacterial therapies. The combination of these two forces poses a potentially grave threat to global health, in both developed and developing countries. Current market forces do not provide appropriate incentives to stimulate new antibiotic development, thus we propose a new incentive mechanism: the Options Market for Antibiotics. This mechanism, modelled on the principle of financial call options, allows payers to buy the right, in early stages of development, to purchase antibiotics at a discounted price if and when they ever make it to market approval. This paper demonstrates the effect of such a model on the expected Net Present Value of a typical antibacterial project. As part of an integrated strategy to confront the impending antibiotic crisis, the Options Market for Antibiotics may effectively stimulate corporate and public investment into antibiotic research and development.


Assuntos
Antibacterianos/uso terapêutico , Descoberta de Drogas/economia , Indústria Farmacêutica/economia , Investimentos em Saúde/organização & administração , Indústria Farmacêutica/estatística & dados numéricos , Humanos , Investimentos em Saúde/estatística & dados numéricos
18.
Hand (N Y) ; 11(4): 438-443, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-28149211

RESUMO

Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suture-button suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated. The thumb metacarpal was then incrementally loaded from 5 to 20 lbs, using 5-lb increments. Metacarpal subsidence during physiological key pinch and incremental loading was determined using radiographic measurements of trapezial space height. Results: The average pretesting trapezial space height did not differ significantly between the LRTI (11.9 mm) and SBS (13.7 mm) groups. After simulated physiological key pinch, the SBS group had significantly greater average trapezial space height compared with the LRTI group (8.0 mm vs 5.5 mm). For each incremental metacarpal load from 5 to 20 lbs, the SBS group had significantly greater average trapezial space height than the LRTI group. Conclusions: In a cadaveric model, SBS demonstrates greater resistance to metacarpal subsidence with immediate loading compared with LRTI.


Assuntos
Articulações Carpometacarpais/cirurgia , Ligamentos Articulares/cirurgia , Osteoartrite/cirurgia , Polegar/cirurgia , Trapézio/cirurgia , Adulto , Idoso , Artrite , Artroplastia , Fenômenos Biomecânicos , Cadáver , Articulações Carpometacarpais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/fisiopatologia , Distribuição Aleatória , Procedimentos Cirúrgicos Reconstrutivos , Suturas , Tendões , Polegar/fisiopatologia
19.
J Antibiot (Tokyo) ; 69(2): 73-88, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26464014

RESUMO

Despite the growing threat of antimicrobial resistance, pharmaceutical and biotechnology firms are reluctant to develop novel antibiotics because of a host of market failures. This problem is complicated by public health goals that demand antibiotic conservation and equitable patient access. Thus, an innovative incentive strategy is needed to encourage sustainable investment in antibiotics. This systematic review consolidates, classifies and critically assesses a total of 47 proposed incentives. Given the large number of possible strategies, a decision framework is presented to assist with the selection of incentives. This framework focuses on addressing market failures that result in limited investment, public health priorities regarding antibiotic stewardship and patient access, and implementation constraints and operational realities. The flexible nature of this framework allows policy makers to tailor an antibiotic incentive package that suits a country's health system structure and needs.


Assuntos
Antibacterianos/isolamento & purificação , Antibacterianos/farmacologia , Descoberta de Drogas/métodos , Descoberta de Drogas/tendências , Política de Saúde , Motivação , Antibacterianos/química , Técnicas de Apoio para a Decisão , Saúde Global , Humanos
20.
J Hand Surg Am ; 40(9): 1905-14, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26243322

RESUMO

Distal radius fractures are among the most common fractures of the upper extremity. Indications for operative and nonsurgical management have evolved over time, as have fixation techniques. Volar locking plates are commonly used in the treatment of selected distal radius fractures such as low-energy or relatively uncomplicated fractures. They have limitations, however, in the management of highly comminuted fracture patterns and in polytrauma patients. In these patients, other methods ranging from spanning fixation to fragment-specific fixation have emerged as useful alternatives in the surgeon's armamentarium for treatment of these challenging fractures.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas do Rádio/cirurgia , Fenômenos Biomecânicos , Placas Ósseas , Fixação Interna de Fraturas/instrumentação , Fraturas Cominutivas/diagnóstico , Humanos , Complicações Pós-Operatórias , Fraturas do Rádio/diagnóstico
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