Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Wrist Surg ; 8(4): 268-275, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31404256

RESUMO

Objective The objective of this article is to evaluate the outcomes and complication rate for Adams-Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure. Methods We conducted a retrospective chart review to evaluate adult patients that had undergone reconstruction of the DRUJ for instability with the Adams-Berger procedure between 1998 and 2015 within our institution with > 24 months follow-up. Charts were reviewed for patient demographics, mechanism of injury, outcome, and complications. Results Ninety-five wrists in 93 patients were included. Mean age at surgery was 37.3 years with 65.2 months follow-up. At the last follow-up, 90.8% had a stable DRUJ, 5.3% did not, and 3.4% had some laxity. Postoperatively, 75.9% described either no pain or mild pain. Grip strength increased while pronosupination decreased. Procedure success was 86.3%, as 12 patients underwent revision at 13.3 months postoperatively. Reconstructive failure was more common in females when an interference screw was utilized for tendon fixation. Age, timing of surgery, type of graft, sigmoid notch anatomy, and previous surgery did not affect revision or failure rate. Conclusion Our findings demonstrate that Adams-Berger reconstruction of the DRUJ provides reliable long-term results with an overall success of 86% at > 5 years follow-up. Level of evidence/Type of study This is a Level IV, therapeutic study.

2.
J Hand Surg Am ; 44(12): 1094.e1-1094.e6, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30902356

RESUMO

PURPOSE: To describe the placement of volar midcarpal portals using the inside-out technique, and the surrounding anatomical structures at risk. METHODS: Five fresh-frozen cadavers were used. Volar ulnar midcarpal (VUMC) and volar radial midcarpal (VRMC) portals were placed using an inside-out technique. The distance between these portals to surrounding anatomical structures was measured in millimeters using a caliper. RESULTS: The VUMC portal pierced the flexor digitorum profundus tendon to the middle finger in 1 specimen. The portal was an average 3.7 and 8.4 mm away from the ulnar artery and nerve, respectively. The VRMC portal pierced the palmaris longus in 2 specimens. It usually was between the flexor pollicis longus, the palmaris longus, and the median nerve. It was an average of 1.0 and 1.95 mm away from the median nerve and palmar cutaneous branch of the median nerve, respectively and in 1 specimen, was in contact with the median nerve after piercing the mesoneurium. CONCLUSIONS: With increasing use of volar midcarpal arthroscopy, the surgeon needs to have an understanding of the structures at risk when placing the VUMC and VRMC portals. CLINICAL RELEVANCE: When developing the volar midcarpal portals, the surgeon needs to pay close attention to the anatomical structures at risk and, in particular, the median nerve from the VRMC portal.

3.
Hand (N Y) ; : 1558944719827999, 2019 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-30762436

RESUMO

BACKGROUND: The purpose of this study was to compare the Vickers physiolysis procedure with osteotomy for correction of digital clinodactyly and determine which method provides better correction at final follow-up or whether the patient's age, preoperative angulation, or presence of syndactyly affects final outcomes. METHODS: All patients of skeletal immaturity who underwent surgical correction of clinodactyly were evaluated with clinical examination and radiographs to determine the percentage and absolute change in the degree of clinodactyly pre- versus postoperatively, in addition to stratification based on the degree of deformity, age, and presence of syndactyly. RESULTS: Vickers' physiolysis and osteotomy were undertaken in 30 and 11 digits, respectively. The angulation significantly improved from 43.0° to 23.9°, with a 46.2% correction of deformity in the Vickers group at 46.3 months. The angulation decreased from 39.2° to 22.4° in the osteotomy group, with a 55.3% correction of deformity at 55.3 months. There was better correction in those with isolated clinodactyly compared with those with concomitant syndactyly and better percentage of correction in patients with lesser deformity in the Vickers group. There were more reoperations in the osteotomy group. CONCLUSIONS: The use of osteotomy may lead to more revision cases, whereas the Vickers procedure has minimal complications and need for revision. The Vickers physiolysis procedure is more effective in those with angulation <55°.

4.
J Plast Reconstr Aesthet Surg ; 72(1): 12-19, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30293962

RESUMO

PURPOSE: There is controversy regarding the effectiveness of brachial plexus reconstruction in older patients, as outcomes are thought to be poor. The aim of this study is to determine the outcomes of shoulder abduction obtained after nerve reconstruction in patients over the age of 50 years and factors related to success. METHODS: Forty patients over the age of 50 years underwent nerve surgery to improve shoulder function after a traumatic brachial plexus injury. Patients were evaluated pre- and postoperatively for shoulder abduction strength and range of motion (ROM); Disability of the Arm, Shoulder and Hand (DASH) scores; pain; age bracket; gender; body mass index (BMI); delay from injury to operation; concomitant trauma; severity of trauma; and type of reconstruction. RESULTS: The average age was 58.2 years (range 50-77 years) with an average follow-up of 18.8 months. The average modified British Medical Research Council (BMRC) shoulder abduction grade improved significantly from 0.23 to 2.03 (p < 0.005). Fourteen patients achieved functional shoulder abduction of ≥ M3 postoperatively. There was no correlation between age or age range stratification and BMRC grade or those obtaining useful shoulder abduction ≥ M3. Active shoulder abduction improved significantly from 18.25° to 40.64°, with no difference on the basis of age or age stratification. There were improved modified BMRC grades with nerve transfers versus nerve grafts. Less patients achieved ≥ M3 function if surgery was delayed > 6 months. The mean DASH score decreased from 45.3 to 40.7 postoperatively, and the average pain score decreased from 3.7 to 3.0. Patients with a higher postoperative BMRC grade for shoulder abduction had improved postoperative DASH scores and VAS for pain (p = 0.011 and 0.005, respectively). CONCLUSION: Brachial plexus nerve reconstruction for shoulder abduction in patients over the age of 50 years can yield useful BMRC scores and ROM, and age should not be used to exclude nerve reconstruction in these patients.


Assuntos
Plexo Braquial/lesões , Procedimentos Neurocirúrgicos/métodos , Idoso , Artroplastia/métodos , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/fisiopatologia , Neuropatias do Plexo Braquial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular/fisiologia , Músculo Esquelético/fisiologia , Transferência de Nervo/métodos , Cuidados Pós-Operatórios/métodos , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
5.
Plast Reconstr Surg ; 143(1): 151-158, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325896

RESUMO

BACKGROUND: There is controversy regarding the effectiveness of brachial plexus reconstruction for elbow function in older patients, as reported outcomes are generally poor. The purpose of this study was to evaluate elbow function outcomes in patients older than 50. METHODS: Fifty-eight patients older than 50 years underwent nerve grafting, transfers, or free functioning muscle transfer to improve elbow function after traumatic brachial plexus injury. Patients were evaluated preoperatively and postoperatively for elbow flexion strength and range of motion; Disabilities of the Arm, Shoulder and Hand scores; pain; concomitant trauma; severity of trauma; and type of reconstruction. RESULTS: The average age of the patients was 57.8 years, and the average follow-up was 24.0 months. The average modified British Medical Research Council elbow flexion grade improved significantly from 0.26 to 2.63. Thirty-three patients (60 percent) achieved functional flexion greater than or equal to M3 postoperatively, compared to zero patients preoperatively. There was no correlation between age and modified British Medical Research Council grade. Active elbow range of motion improved significantly postoperatively, with no effect of age on flexion motion. More patients achieved greater than or equal to M3 flexion with nerve transfers (69 percent) compared to free functioning muscle transfer (43 percent). Patients had worse outcomes with high-energy injuries. The mean Disabilities of the Arm, Shoulder and Hand score decreased from 51.5 to 49.6 postoperatively, and the average pain score decreased from 5.0 to 4.3. CONCLUSION: Brachial plexus reconstruction for elbow function in patients older than 50 can yield useful flexion. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Plexo Braquial/lesões , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Procedimentos Neurocirúrgicos/métodos , Amplitude de Movimento Articular/fisiologia , Idoso , Neuropatias do Plexo Braquial/diagnóstico , Neuropatias do Plexo Braquial/cirurgia , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Transferência de Nervo/métodos , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento , Ferimentos e Lesões
6.
Plast Surg (Oakv) ; 26(3): 165-168, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30148128

RESUMO

Purpose: Surgeons and resident physicians in a clinic setting often visually estimate Dupuytren flexion contractures of the hand to follow disease progression and decide on management. No previous study has compared visual estimates with a standardized instrument to ensure measurement reliability. Methods: Consecutive patients consulted for Dupuytren flexion contractures of the hand had individual joint contractures estimated in degrees (°) by both a resident physician and staff surgeon. Estimates were compared with goniometer measurements to generate intraclass correlation coefficients (ICCs), and residents and surgeons were compared based on their accuracy. Results: Twenty-eight patients enrolled in this study, which provided a total of 80 hand joints for analysis. Resident physicians achieved an ICC of 0.42, which indicates poor reliability. The hand surgeon achieved an ICC of 0.86, which indicates high reliability. The surgeon also had better accuracy than the residents. Conclusion: Hand surgeons should be mindful of the limitations of visual estimates of Dupuytren flexion contractures, particularly when conducted by trainees. Joint angle measurements taken for the purposes of research should be done with a goniometer at minimum.

7.
JBJS Case Connect ; 8(2): e37, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29901478

RESUMO

CASE: We describe a patient with Bain grade-2b Kienböck disease with a coronal fracture of the distal lunate articular surface with proximal structure collapse. To reestablish midcarpal congruity, we used a bone-anchored suture to repair the coronal split in the lunate in preparation for lunate preservation with osteochondral medial femoral trochlea (MFT) reconstruction. CONCLUSION: In Bain grade-2b Kienböck disease, lunate reconstruction of both the proximal and distal joint surfaces can be performed. Successful reconstruction of the distal articular surface can be achieved using a bone-anchored FiberWire (Arthrex) suture technique. This can be employed in conjunction with an osteochondral MFT reconstruction of the proximal aspect of the lunate. Patients with this commonly encountered coronal fracture of the distal articular surface may be considered candidates for lunate reconstruction via this technique rather than conventional ablative procedures.


Assuntos
Fraturas Ósseas/cirurgia , Traumatismos da Mão/cirurgia , Osso Semilunar , Osteonecrose/complicações , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Fraturas Ósseas/etiologia , Traumatismos da Mão/etiologia , Humanos , Osso Semilunar/lesões , Osso Semilunar/cirurgia , Masculino , Amplitude de Movimento Articular
8.
J Plast Reconstr Aesthet Surg ; 70(8): 1044-1050, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28572044

RESUMO

PURPOSE: To date, there have been no studies identifying the cost differential for performing closed reduction internal fixation (CRIF) of hand fractures in the operating room (OR) versus an ambulatory setting. Our goal was to analyse the cost and efficiency of performing CRIF in these two settings and to investigate current practice trends in Canada. METHODS: A detailed analysis of the costs involved both directly and indirectly in the CRIF of a hand fracture was conducted. Hospital records were used to calculate efficiency. A survey was distributed to practicing plastic surgeons across Canada regarding their current practice of managing hand fractures. RESULTS: In an eight-hour surgical block we are able to perform five CRIF in the OR versus eight in an ambulatory setting. The costs of performing a CRIF in the OR under local anaesthetic, not including surgeon compensation, is $461.27 Canadian (CAD) compared to $115.59 CAD in the ambulatory setting, a 299% increase. The use of a regional block increases the cost to $665.49 CAD, a 476% increase. The main barrier to performing CRIFs in an outpatient setting is the absence of equipment necessary to perform these cases effectively, based on survey results. CONCLUSION: The use of the OR for CRIF of hand fractures is associated with a significant increase in cost and hospital resources with decreased efficiency. For appropriately selected hand fractures, CRIF in an ambulatory setting is less costly and more efficient compared to the OR and resources should be allocated to facilitate CRIF in this setting.


Assuntos
Instituições de Assistência Ambulatorial/economia , Redução Fechada/economia , Fixação Interna de Fraturas/economia , Fraturas Ósseas/economia , Traumatismos da Mão/cirurgia , Custos de Cuidados de Saúde , Salas Cirúrgicas/economia , Anestesia Local/economia , Canadá , Custos e Análise de Custo , Eficiência , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Traumatismos da Mão/economia , Humanos , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Bloqueio Nervoso/economia , Equipamentos Cirúrgicos
11.
Plast Reconstr Surg ; 128(5): 419e-426e, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22030502

RESUMO

BACKGROUND: The internal mammary artery perforator flap is a versatile flap used for reconstruction of the head and neck. Using dissection, angiograms, and three-dimensional reconstruction, the authors describe the vascular anatomy of the internal mammary perforator arteries, including their course, diameter, location of perforation, and relationship to other tissues (e.g., bone, muscle, and skin). METHODS: Fourteen fresh cadavers were injected with either latex or a lead oxide/gelatin mixture and dissected to show the anatomy of the internal mammary artery perforators. Plain film and computed tomographic angiograms were obtained and analyzed on the lead oxide-injected cadavers. The computed tomographic angiography Digital Imaging and Communications in Medicine images were imported into Materialise's Interactive Medical Imaging Control System software to produce three-dimensional reconstructions of the internal mammary artery perforator anatomy. RESULTS: The second internal mammary artery perforator was the dominant perforator in 10 of the 14 cadavers. The mean emerging diameter of the dominant second perforator was 1.0±0.4 mm, with a mean superficial length of 51.8±16.1 mm on the latex-injected and lead oxide-injected cadaver angiograms. The mean distance from the sternal margin to the point of emergence from the internal mammary artery was 7±1.4 mm. The three-dimensional reconstructions demonstrated anastomoses between the dominant perforator and the lateral thoracic artery. CONCLUSIONS: The vascular anatomy of the internal mammary artery perforators was documented using cadaveric dissections, angiograms, and computed tomographic angiograms analyzed with Materialise's Interactive Medical Imaging Control System. The diameter, point of perforation, course, and relationship to surrounding anatomical structures has been shown using a vascular injection technique and three-dimensional reconstructions.


Assuntos
Angiografia/métodos , Mama/irrigação sanguínea , Imageamento Tridimensional , Artéria Torácica Interna/anatomia & histologia , Artéria Torácica Interna/diagnóstico por imagem , Retalhos Cirúrgicos/irrigação sanguínea , Mama/anatomia & histologia , Cadáver , Meios de Contraste/farmacologia , Dissecação , Feminino , Humanos , Artéria Torácica Interna/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA