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1.
Bone Joint J ; 102-B(1): 72-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888363

RESUMO

AIMS: The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with early death. METHODS: This was a retrospective cohort study of consecutive patients referred to the orthopaedic department at a UK trauma centre with a proximal femoral metastasis (PFM) over a seven-year period (2010 to 2016). The study group were compared to a matched control group of non-metastatic hip fractures. Minimum follow-up was one year. RESULTS: There was a 90-day mortality of 46% in patients with metastatic hip fractures versus 12% in controls (89/195 and 24/192, respectively; p < 0.001). Mean time to surgery was longer in symptomatic metastases versus complete fractures (9.5 days (SD 19.8) and 3.4 days (SD 11.4), respectively; p < 0.05). Albumin, urea, and corrected calcium were all independent predictors of early mortality and were used to generate a simple tool for predicting 90-day mortality, titled the Metastatic Early Prognostic (MEP) score. An MEP score of 0 was associated with the lowest risk of death at 30 days (14%, 3/21), 90 days (19%, 4/21), and one year (62%, 13/21). MEP scores of 3/4 were associated with the highest risk of death at 30 days (56%, 5/9), 90 days (100%, 9/9), and one year (100%, 9/9). Neither age nor primary cancer diagnosis was an independent predictor of mortality at 30 and 90 days. CONCLUSION: This score could be used to predict early mortality and guide perioperative counselling. The delay to surgery identifies a potential window to intervene and correct these abnormalities with the aim of improving survival. Cite this article: Bone Joint J. 2020;102-B(1):72-81.


Assuntos
Neoplasias Femorais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Estudos de Casos e Controles , Feminino , Neoplasias Femorais/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Escócia/epidemiologia , Índice de Gravidade de Doença , Análise de Sobrevida , Tempo para o Tratamento
2.
Acta Orthop Belg ; 85(2): 192-198, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31315009

RESUMO

We describe the functional and radiological results at minimum 15 years follow up of four groups of total hip replacement(THR) implants used in our health region. 876 THRs in 837 patients who were included in the study that used prospectively collected data in the Tayside Arthroplasty Audit Group(TAAG) database. There were 387 Charnley/Ogee cemented THRs, 188 hips in the cemented CPT/ZCA group, 106 hips in the uncemented Bicontact/Plasmacup group and 195 hips in the hybrid Exeter/Trident group. The most common complications were dislocation (3.88%) and superficial infection (3.76%). With revision surgery for any reason as the end point, the survivorship of at 15 years in our series was 98.45% in the cemented Charnley/Ogee THR group, 96.8% in the cemented CPT/ZCA group, 96.22% in the uncemented Bicontact/Plasmacup group and 97.94% in the Exeter/Trident hybrid THR group. There was no statistically significant difference in the number of hips at risk of revision, Harris Hip Scores and complication rates at 15 years. We feel that the choice of implant is best based on individual templating and training of the surgeon. Prospective randomised controlled trials and joint registry data may make implant selection easier in the future.


Assuntos
Artroplastia de Quadril/efeitos adversos , Prótese de Quadril/efeitos adversos , Luxações Articulares/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Artroplastia de Quadril/métodos , Cimentos para Ossos , Feminino , Seguimentos , Humanos , Incidência , Luxações Articulares/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/etiologia , Sistema de Registros , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Reino Unido
3.
Surgeon ; 17(3): 156-159, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935878

RESUMO

NCS are often routinely performed for CTS despite recommendations from the BOA, BSSH and NICE that they are associated with increased costs and prolonged waiting times. This prospective study aimed to assess if the Kamath and Stothard clinical questionnaire could accurately predict nerve conduction study (NCS) results when diagnosing carpal tunnel syndrome (CTS). Eighty-eight patients referred with signs and symptoms of CTS from September 2016 to February 2017 were included. All patients were assessed by specialist hand therapists using the Kamath and Stothard carpal tunnel questionnaire (CTQ) and all patients independently underwent NCS by neurophysiologists. We compared results of CTQ score versus NCS findings. Results showed that a CTQ score of less than 3 correlated 100% to negative NCS. When the CTQ score was more than or equal to 5, 90% of patients had a positive NCS result. For patients with a CTQ score of 3 or 4, the NCS could not be reliably predicted. These findings suggest that the Kamath and Stothard CTQ is a useful tool in determining which patients may require NCS. We suggest that only patients with a CTQ score of 3 or 4 and with equivocal signs and symptoms should undergo NCS. The questionnaire has the potential to be used as a primary tool for diagnosing CTS, with significant cost savings and reduction in waiting times for NCS.


Assuntos
Síndrome do Túnel Carpal/diagnóstico , Condução Nervosa , Inquéritos e Questionários , Adulto , Idoso , Síndrome do Túnel Carpal/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Método Simples-Cego
4.
Hip Pelvis ; 31(1): 18-22, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30899711

RESUMO

Purpose: Occult hip fractures in the elderly can be missed on standard radiographs and are a known cause of morbidity. These are generally diagnosed on either magnetic resonance imaging (MRI) or computed tomography scan, depending upon local hospital policy. While there is an abundance of literature on hip fractures in general, little is known about the clinical outcome of patients with occult hip fractures. The aim of this study was to review the demographics, injury characteristics, management and clinical outcome of patients diagnosed with occult femoral neck fractures on MRI. Materials and Methods: Using an existing hospital database, a retrospective analysis of all patients with occult hip fractures diagnosed by MRI scan from 2005 to 2014 was conducted. Results: Sixty-four patients (23 males and 41 females) were included. The mean duration of hospitalisation was 16 days. A significantly higher percentage of patients were discharged to their pre-existing residence compared to National Institute for Health and Care Excellence (NICE) commissioning guidelines (66% vs. 45%). The 30- and 60-day mortalities were 3% and 10%, respectively. Mortality was lower in patients who underwent internal fixation (n=3/31) compared with those undergoing replacement (hemi/total hip arthroplasty) (n=5/12) (P=0.056). Conclusion: Patients with occult hip fractures diagnosed on an MRI scan are more likely to be discharged to their pre-existing residence and have lower mortality rates compared to NICE guidelines and National Hip Fracture Database (NHFD).

5.
Surgeon ; 17(4): 207-214, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30145044

RESUMO

AIMS: Investigate awareness in the multidisciplinary orthopaedic trauma team regarding intimate partner violence (IPV), willingness to ask patients and knowledge of available support. METHODS: Orthopaedic staff in several UK centres completed an anonymous online validated questionnaire reflecting their opinions on IPV in orthopaedics. Respondents from orthopaedic surgery, nursing, and physiotherapy participated. RESULTS: There were 121 respondents with a mean 10 years' experience. 52% of respondents had previously had a disclosure of IPV from at least one orthopaedic patient. Doctors and nurses were equally likely to have cared for IPV patients (50% versus 56%), but doctors thought abuse was less common (57% doctors compared to 15% nurses thought IPV affected less than 1% of trauma patients, p < 0.05). 74% of respondents reported asking patients about abuse (77/104 answered) but only 24% (29/121) knew about the support currently available. Staff who did not know about available support were less likely to ask about possible abuse (46% versus 22% respectively, p < 0.05). 74% of respondents felt it was important/very important to ask about IPV. CONCLUSIONS: This is the first study investigating IPV in UK orthopaedics. Although three quarters of the staff interviewed thought that it was important to ask trauma patients about IPV, only 2% routinely ask patients presenting with musculoskeletal injuries about IPV. Orthopaedic staff are well placed to identify vulnerable patients. This study highlights the need for training staff on how to identify IPV and manage disclosures of abuse given that the incidence of IPV is on the increase.


Assuntos
Conscientização , Violência por Parceiro Íntimo , Sistema Musculoesquelético/lesões , Ortopedia , Equipe de Assistência ao Paciente , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Reino Unido
7.
Acta Orthop ; 89(2): 152-155, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29345170

RESUMO

Background and purpose - About 86,000 total hip replacements (THR) have been registered in patients under 55 years in the National Joint Registry of England and Wales (NJR). The use of uncemented implants has increased, despite their outcomes not having been proven to be significantly better than cemented implants in this registry. We determined the implant survivorship and functional outcomes of cemented THR in patients under 55 years at a minimum follow-up of 22 years. Patients and methods - 104 hips in 100 patients were included in this prospective study. Functional outcome was assessed using the Harris Hip Score and radiographs were assessed for implant failure and "at risk" of failure. Kaplan-Meier survivorship analysis was performed. Results - 89% of hips showed good to excellent results at final follow-up with a mean Harris Hip Score of 88 at a mean follow-up of 25 years. Revision was performed in 3/104 hips. 14 acetabular components and 4 femoral components were "at risk" of failure. The survivorship at minimum 22 years with revision for any reason as the end-point was 97% (95% CI 95-98). Interpretation - Cemented hip replacements perform well in young patients with good long-term functional and radiographic outcomes.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Cimentação , Prótese de Quadril , Artropatias/cirurgia , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Adolescente , Adulto , Fatores Etários , Artroplastia de Quadril/efeitos adversos , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Artropatias/epidemiologia , Artropatias/patologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação , Resultado do Tratamento , País de Gales/epidemiologia , Adulto Jovem
8.
J Hand Surg Asian Pac Vol ; 22(3): 286-291, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28774245

RESUMO

BACKGROUND: Scaphoid non-union is often caused due to missed fractures, inadequate or inappropriate management. Matti-Russe and interpositional grafting techniques are used in the treatment of non-union. There are very few studies in literature that compare the outcomes of these techniques. The aim of our study was to analyse the factors influencing outcome in the management of scaphoid non-union and to compare the results of the Matti Russe procedure with interpositional grafting techniques. METHODS: Fifty scaphoid non-unions with a mean follow-up of 39.9 ± 5.5 months were included in this retrospective study. Demographic parameters, treatment, functional and radiological outcomes were recorded. The influence of demographic and treatment factors on union in this cohort was statistically analysed. RESULTS: Union was achieved in 76% of cases. Good to excellent results were achieved in 84% of patients. There was no significant difference in union rates, deformity correction achieved and period of immobilisation between the MR and IG techniques. The occurrence of arthritic changes correlated with the time interval between injury and surgery (p = 0.002). CONCLUSIONS: The most important factor that influences the outcome is the time period between the occurrence of the fracture and surgery for non-union. The Matti-Russe procedure can achieve comparable results to interpositional grafting techniques with a shorter period of immobilisation than previously thought to be required. We believe that the presence of a deformity is not a contraindication for the procedure.


Assuntos
Transplante Ósseo/métodos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Consolidação da Fratura , Humanos , Ílio/transplante , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/transplante , Estudos Retrospectivos , Osso Escafoide/lesões , Adulto Jovem
9.
J Arthroplasty ; 32(7): 2256-2261, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28336248

RESUMO

BACKGROUND: Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA. METHODS: In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared. RESULTS: The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness. CONCLUSION: Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cicatriz/complicações , Hipestesia/epidemiologia , Articulação do Joelho/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reino Unido/epidemiologia
10.
Orthop Surg ; 8(4): 511-515, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28032713

RESUMO

Synovial chondromatosis is a rare and benign condition of unknown cause. It is also known as synovial osteochondromatosis. It is characterized by involvement of the synovial tissue, which lines various joints of our body. Initial symptoms range from pain in the joint, locking of the joint at times, especially the knee, to arthritis of the joint that is a late feature of this condition. Although large joints such as the knee are commonly affected, involvement of the shoulder joint is a rare occurrence. Historically an open arthrotomy was preferred for removal of loose bodies coupled with a thorough synovectomy. However, arthroscopy for loose body retrieval has gained popularity over the past two decades. Arthroscopic surgery is an extremely skilled procedure and there is a learning curve for operating in certain anatomical areas such as the shoulder. However, not only does an arthroscopy provide the surgeon with an excellent view of the shoulder but the patient also has a faster recovery. We report a rare case of shoulder synovial chondromatosis in which more than 100 loose bodies were successfully retrieved by an arthroscopy in an individual who had an excellent outcome post-surgery, reaffirming our faith in the procedure. A detailed literature review of arthroscopic procedures is also presented.


Assuntos
Artroscopia , Condromatose Sinovial/cirurgia , Articulação do Ombro/cirurgia , Condromatose Sinovial/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Articulação do Ombro/diagnóstico por imagem
11.
Orthop Surg ; 8(1): 85-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27028386

RESUMO

Dislocation of any joint is an orthopaedic emergency and needs immediate attention by the attending physician. A delay in reducing a dislocated joint can lead to disastrous complications both immediately as well as in the long run. Although anterior dislocation of a shoulder joint is by far the commonest dislocation encountered by any emergency care physician, other joints may also get dislocated. In certain cases two joints may get dislocated simultaneously. Such dislocation is known as a double dislocation. Double dislocation of the proximal interphalangeal joint and the distal interphalangeal joint in the same finger is a rare injury. High impact loading at the fingertip is the primary cause in most cases and it is often associated with younger individuals playing contact sports. The right little finger is the digit commonly involved and this injury is evident in football players more often than not. Although closed reduction is a preferred treatment, it may not be always successful. Time of presentation, tendon interposition, associated swelling and co-existent phalangeal fractures are certain key impediments to a successful closed reduction manoeuvre. In patients with an open injury, a thorough wash out and appropriate antibiotic cover is mandatory. We report a rare case of double dislocation of the interphalangeal joints accompanied with contralateral shoulder dislocation in an elderly man sustained after a fall which was treated successfully with closed reduction and early mobilization.


Assuntos
Acidentes por Quedas , Traumatismos dos Dedos/terapia , Falanges dos Dedos da Mão/lesões , Luxações Articulares/terapia , Traumatismo Múltiplo/terapia , Procedimentos Ortopédicos/métodos , Idoso , Traumatismos dos Dedos/complicações , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Traumatismo Múltiplo/diagnóstico por imagem , Radiografia , Luxação do Ombro/complicações , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/terapia
12.
J Shoulder Elbow Surg ; 25(6): 954-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26776945

RESUMO

BACKGROUND: Given the degree of variation in clavicular morphology, 4 clavicle plating systems were examined for their congruity as superior, midshaft, anatomic clavicle (SMAC) plates in a cadaveric study. METHODS: SMAC plates from 4 manufacturers were applied to 79 dry right human clavicles. Two systems offered multiple (4) variations of plates (MP), 1 offered two variations (TP), and 1 had a single plate (SP). Two examiners applied and clamped the best-fitting plate from each system onto each of the 79 clavicles and then graded them: 1, poor fit; 2, good fit; and 3, anatomic fit. Each examiner repeated the process to assess intraobserver and interobserver reliability. The scores were averaged to produce a final score for each system for each clavicle. RESULTS: The MP systems scored the highest (32%-37% anatomic, 54%-63% good, 5%-8% poor), followed by the TP system (30% anatomic, 53% good, 17% poor), and finally the SP system (9% anatomic, 59% good, 32% poor). Of note, clavicular length significantly correlated with a higher degree of conformity in all plating systems (Spearman rank correlation P < .05 for each system). In clavicles longer than 150 mm, the MP and TP systems performed identically, with the SP system close behind. Contouring of the plate is needed in 73% of cases overall. CONCLUSION: Plating systems with multiple plate shape variations are more advantageous when dealing with smaller-sized clavicles, typically in females. However, when dealing with larger clavicles, there was no real difference.


Assuntos
Placas Ósseas , Clavícula/anatomia & histologia , Fixação Interna de Fraturas/instrumentação , Adulto , Cadáver , Diáfises/anatomia & histologia , Desenho de Equipamento , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes , Fatores Sexuais
13.
Tech Hand Up Extrem Surg ; 20(1): 1-5, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26630656

RESUMO

Tension band wiring of simple transverse olecranon fractures results in a high reoperation rate due to hardware problems. A technique using high-strength braided polyester and polyethylene suture through a bone tunnel has been piloted. This technique is suitable for simple transverse olecranon fractures or olecranon osteotomy with stability of the ulnohumeral articulation. A transverse drill hole was made in the ulna with a 2.5-mm drill. Fracture fixation was achieved using 2 braided synthetic sutures passed through the bone tunnel and grasping the insertion of the triceps tendon. The outcome measures used were Oxford Elbow score and QuickDASH score. Ten consecutive patients with a mean age of 47 years (range, 18 to 88 y) were included. The mean follow-up was 19 months (range, 14 to 30 mo). All fractures were clinically and radiographically united by 6 weeks. One malunion occurred. The mean Oxford score was 41 (20 to 48). The mean QuickDASH Score was 9 (0 to 20). This technique provides a safe and reliable alternative to conventional tension band wiring with no reoperations required in a pilot series.


Assuntos
Olécrano/lesões , Olécrano/cirurgia , Osteotomia/métodos , Fraturas da Ulna/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Técnicas de Sutura , Suturas , Adulto Jovem
14.
Indian J Orthop ; 49(2): 233-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26015615

RESUMO

BACKGROUND: Total elbow replacement (TER) is indicated in inflammatory arthritis, osteoarthritis and fractures that are not amenable to reconstruction. There is no series in literature, to the best of our knowledge, regarding the results of revision of the Souter-Strathclyde prosthesis (SSP) to the Coonrad-Morrey prosthesis (CMP). The aim of this study is to present the medium term results of primary CMP total elbow replacement and revision of the SSP to CMP. MATERIALS AND METHODS: 50 primary CMPs (Group I) and 11 revision CMPs (Group II) were included in the study. Demographic, operative, followup and radiological data were analysed. The indication for revision of the primary implant was peri-prosthetic fracture in six cases, aseptic loosening in four cases and instability in one case. RESULTS: The mean age in Group I was 67.28 ± 12.45 years and in Group II was 57.09 ± 11.25 years. The mean period of followup was 8.08 ± 2.95 years and 7.46 ± 2.39. There was a significant improvement in range of motion and pain in both groups. The complications seen were nerve palsy, infection, fractures and heterotopic ossification. The 5-year survival rate in Group I was 94%. The results were good in 36 elbows, fair in 8 elbows and poor in 5 elbows. In Group II, the results were good in 8 elbows, fair in 2 elbows and poor in 1 elbow. The complications seen were nerve palsy, fractures and heterotopic ossification. DISCUSSION: Primary CMP TER provides a functionally useful range of movement of 100° which is enough to perform most activities of daily living. It also produces a pain free and stable joint. Similar results are achieved after revision of the SSP to CMP. The unique toggle-hinge mechanism of articulation provides inherent stability and good survivorship. CONCLUSION: Semiconstrained prostheses like CMP provide good functional results and survivorship and are the implant of choice in both primary and revision total elbow replacements.

15.
J Med Case Rep ; 8: 329, 2014 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-25294274

RESUMO

INTRODUCTION: Incarceration of the medial epicondyle is a well-recognised sequelae following closed reduction of the elbow. Manipulation for extraction is not usually successful and hence an incarcerated medial epicondyle is usually an indication for open reduction and fixation. CASE PRESENTATION: We describe a simple technique of closed reduction using a conventional nerve stimulator to extract an incarcerated medial epicondyle in a 13-year-old Caucasian boy. This technique uses contraction of the attached common flexor muscles to indirectly extract the trapped medial epicondyle. CONCLUSIONS: This is a simple technique using a commonly available nerve stimulator and may obviate the need for extensile open reduction for extraction of the incarcerated medial epicondyle. We would recommend this technique where closed reduction methods have failed.


Assuntos
Articulação do Cotovelo/lesões , Luxações Articulares/terapia , Manipulação Ortopédica/métodos , Estimulação Elétrica Nervosa Transcutânea , Adolescente , Humanos , Masculino
16.
Int J Shoulder Surg ; 8(2): 51-4, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25114416

RESUMO

Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication.

17.
J Shoulder Elbow Surg ; 23(4): 500-7, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24630545

RESUMO

BACKGROUND: There is little evidence for the optimal form of nonoperative treatment in the management of frozen shoulder. This study assesses the efficacy of current physiotherapy strategies. METHODS: All primary care referrals of frozen shoulder to our physiotherapy department were included during a 12-month period. Of these referrals, 17% met the inclusion criteria for primary idiopathic frozen shoulder. The 75 patients were randomly assigned to 1 of 3 groups: group exercise class, individual physiotherapy, and home exercises alone. A single independent physiotherapist, who was blinded to the treatment groups, made all assessments. Range of motion, Constant score, Oxford Shoulder Score, Short Form 36, and Hospital Anxiety and Disability Scale (HADS) outcome measures were performed at baseline, 6 weeks, 6 months, and 1 year. RESULTS: The exercise class group improved from a mean Constant score of 39.8 at baseline to 71.4 at 6 weeks and 88.1 at 1 year. There was a significant improvement in shoulder symptoms on Oxford and Constant scores (P < .001). This improvement was greater than with individual physiotherapy or home exercises alone (P < .001). The improvement in range of motion was significantly greater in both physiotherapy groups over home exercises (P < .001). HADS scores significantly improved during the course of treatment (P < .001). The improvement in HADS anxiety score was significantly greater in both physiotherapy intervention groups than in home exercises alone. CONCLUSIONS: A hospital-based exercise class can produce a rapid recovery from a frozen shoulder with a minimum number of visits to the hospital and is more effective than individual physiotherapy or a home exercise program.


Assuntos
Bursite/terapia , Terapia por Exercício , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Método Simples-Cego , Resultado do Tratamento
18.
J Wrist Surg ; 3(1): 60-3, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24533249

RESUMO

A thorough knowledge of the anatomy of the terminal branch of the posterior interosseous nerve (PIN) and its relationship to the anterior interosseous nerve (AIN) is essential in facilitating regional anesthetic blocks and planning surgical exposures for wrist surgery and arthrodesis of wrist and proximal row carpectomy. This cadaveric study focused on the anatomy and course of the PIN and its anatomical relationships at the distal forearm. Thirty embalmed cadaver forearms were dissected using microsurgical techniques. A structured pro forma was used to collect data. The PIN was consistently found in the fourth extensor compartment in all specimens. The last motor branch was given off 46.9 ± 8.4 mm (mean ± standard deviation) from the most proximal part of the ulnar head. The AIN was found lying consistently on the anterior aspect of the interosseous membrane, being on average 2.8 ± 0.2 mm (mean ± standard deviation) from the PIN. This knowledge will facilitate the planning of diagnostic and therapeutic procedures associated with the wrist.

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