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1.
Instr Course Lect ; 69: 291-316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017734

RESUMO

In this chapter, the authors describe hand conditions that can be "bad actors" and provide specific clues to identify these problems, and strategies to assess and successfully treat them. We will review pediatric and adult hand fractures, fractures of the distal radius, and trigger digits.


Assuntos
Fraturas do Rádio , Traumatismos do Punho , Articulação do Punho , Adulto , Criança , Fixação Interna de Fraturas , Humanos , Punho
2.
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
3.
Aging Cell ; 18(3): e12934, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30938056

RESUMO

Age-related tendon degeneration (tendinosis) is characterized by a phenotypic change in which tenocytes display characteristics of fibrochondrocytes and mineralized fibrochondrocytes. As tendon degeneration has been noted in vivo in areas of decreased tendon vascularity, we hypothesized that hypoxia is responsible for the development of the tendinosis phenotype, and that these effects are more pronounced in aged tenocytes. Hypoxic (1% O2 ) culture of aged, tendinotic, and young human tenocytes resulted in a mineralized fibrochondrocyte phenotype in aged tenocytes, and a fibrochondrocyte phenotype in young and tendinotic tenocytes. Investigation of the molecular mechanism responsible for this phenotype change revealed that the fibrochondrocyte phenotype in aged tenocytes occurs with decreased Rac1 activity in response to hypoxia. In young hypoxic tenocytes, however, the fibrochondrocyte phenotype occurs with concomitant decreased Rac1 activity coupled with increased RhoA activity. Using pharmacologic and adenoviral manipulation, we confirmed that these hypoxic effects on the tenocyte phenotype are linked directly to the activity of RhoA/Rac1 GTPase in in vitro human cell culture and tendon explants. These results demonstrate that hypoxia drives tenocyte phenotypic changes, and provide a molecular insight into the development of human tendinosis that occurs with aging.

4.
J Bone Joint Surg Am ; 100(19): e127, 2018 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-30278004

RESUMO

BACKGROUND: Although orthopaedic surgeons have been shown to prescribe excessive amounts of opioid analgesics postoperatively, the degree in which surgical trainees contribute to this trend is unknown. The purpose of this study was to compare self-reported opioid-prescribing behavior, factors influencing this behavior, and perceptions of patient opioid utilization and disposal between hand surgeons and trainees. METHODS: Attending hand surgeons and trainees in hand, orthopaedic, and plastic surgery programs were invited to participate in a web-based survey including demographic characteristics; self-reported prescribing behavior specific to 4 procedures: open carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, and distal radial fracture open reduction and internal fixation; and perceptions and influencing factors. Analgesic medications were converted to morphine milligram equivalents and were compared across groups of interest using independent t tests or analysis of variance for each procedure. RESULTS: A total of 1,300 respondents (266 attending surgeons, 98 fellows, 708 orthopaedic residents, and 228 plastic surgery residents) were included. Surgeons reported prescribing fewer total morphine milligram equivalents compared with residents for all 4 procedures. Personal experience was the most influential factor for prescribing behavior by surgeons and fellows. Although residents reported that attending surgeon preference was their greatest influence, most reported no direct opioid-related communication with attending surgeons. CONCLUSIONS: Residents self-report prescribing significantly higher morphine milligram equivalents for postoperative analgesia following commonly performed hand and wrist surgical procedures than attending surgeons. Poor communication between residents and attending surgeons may contribute to this finding. Residents may benefit from education on opioid prescription, and training programs should encourage direct communication between trainees and attending surgeons.


Assuntos
Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Mãos/cirurgia , Internato e Residência , Procedimentos Ortopédicos , Ortopedia , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Cuidados Pós-Operatórios/normas , Padrões de Prática Médica , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Punho/cirurgia , Humanos , Corpo Clínico Hospitalar , Ortopedia/educação , Autorrelato , Cirurgia Plástica/educação , Estados Unidos
5.
Hand (N Y) ; : 1558944718760034, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29504476

RESUMO

BACKGROUND: The purpose of this study was to identify factors associated with unplanned reoperation after surgery for scapholunate interosseous ligament (SLIL) insufficiency. METHODS: Using Current Procedural Terminology (CPT) codes from 3 hand surgery centers across 2 metropolitan areas, we identified 316 patients undergoing surgery for SLIL insufficiency from 2000 to 2014. Medical records were manually reviewed to collect data on factors that might be associated with unplanned reoperation, including age, sex, tobacco use, occupation, acuity of treatment, and reconstruction method. RESULTS: Thirty-eight patients (12%) had an unplanned reoperation; most of them (65%) were a secondary reconstruction or salvage procedure (eg, 6 proximal row carpectomies, 9 revision reconstruction, and 10 partial carpal arthrodeses), while 5 (13%) were for unplanned screw removal. The median time between the index and second surgery was 16 months (range, 2-97 months). The type of index procedure was not associated with reoperation. The only factor associated with reoperation was cigarette smoking, and this association persisted when looking specifically at reoperations for revision or salvage. CONCLUSIONS: Patients should be counseled that smoking is associated with reoperation after SLIL surgery. Smoking cessation or decreasing nicotine usage may be beneficial prior to surgery. With the numbers available, there was no association between surgical technique and reoperation.

6.
J Hand Surg Am ; 43(9): 873.e1-873.e4, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29526530

RESUMO

Accidental needlestick injuries are common in laboratory and health care workers. Injection of atypical pathogens, such as those encountered in the animal laboratory setting, may pose considerable problems at the site of inoculation. We present the case of an otherwise healthy laboratory worker who accidentally self-injected Freund complete adjuvant with heat-killed Mycobacterium tuberculosis into her hand, requiring multiple debridement operations over a prolonged treatment course.


Assuntos
Adjuvante de Freund/administração & dosagem , Traumatismos da Mão/terapia , Mycobacterium tuberculosis , Ferimentos Penetrantes Produzidos por Agulha/terapia , Acidentes de Trabalho , Adulto , Desbridamento , Feminino , Adjuvante de Freund/efeitos adversos , Glucocorticoides/uso terapêutico , Granuloma/etiologia , Granuloma/cirurgia , Humanos , Pessoal de Laboratório , Metilprednisolona/uso terapêutico , Glicoproteína Mielina-Oligodendrócito/administração & dosagem , Glicoproteína Mielina-Oligodendrócito/efeitos adversos , Ferimentos Penetrantes Produzidos por Agulha/complicações , Fragmentos de Peptídeos/administração & dosagem , Fragmentos de Peptídeos/efeitos adversos , Triancinolona Acetonida/uso terapêutico
7.
J Bone Joint Surg Am ; 100(5): 416-427, 2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29509619

RESUMO

BACKGROUND: The purpose of this study was to report our long-term outcomes following reconstruction of the forearm interosseous membrane (IOM) with bone-patellar tendon-bone (BPTB) graft for treatment of chronic Essex-Lopresti injuries. METHODS: We identified 33 patients who underwent IOM reconstruction with BPTB graft for chronic Essex-Lopresti injuries over a 20-year treatment interval. Twenty male and 13 female patients, with a mean age of 42.1 years (range, 19 to 73 years) and a minimum follow-up interval of 5 years, were included. Preinjury clinical examination and radiographic measurements were obtained from records for comparison with prospectively collected data. Additional functional outcome data collected postoperatively included QuickDASH (an abbreviated version of the Disabilities of the Arm, Shoulder and Hand [DASH]), modified Mayo wrist (MMW), and Broberg-Morrey elbow function scores. RESULTS: IOM reconstruction was performed at a mean interval (and standard deviation) of 44.9 ± 60.0 months (range, 6.4 to 208 months) from the time of the initial injury. At a mean follow-up of 10.9 ± 4.4 years (range, 5.5 to 24.2 years), significant improvements were observed in mean elbow flexion-extension arc (+13° [95% confidence interval (CI), 4° to 22°]; p = 0.005), wrist flexion-extension arc (+19° [95% CI, 4° to 34°]; p = 0.016), forearm pronation-supination (+23° [95% CI, 8° to 39°]; p = 0.004), and grip strength (+25% of that of the contralateral side [95% CI, 18% to 32% of contralateral side]; p < 0.001). Improvements in ulnar variance were sustained over the long term from +3.9 mm (95% CI, 3.2 to 4.6 mm) preoperatively to -1.6 mm (95% CI, -2.3 to -0.9 mm) immediately postoperatively and -1.1 mm (95% CI, -1.8 to -0.4 mm) at the time of the final follow-up (p < 0.001). The mean QuickDASH, MMW, and Broberg-Morrey scores were 29.8 (range, 5 to 61), 82.7 (range, 60 to 100), and 91.6 (range, 64 to 100), respectively. CONCLUSIONS: IOM reconstruction with a BPTB graft is an effective treatment option for chronic Essex-Lopresti injuries, with satisfactory clinical and functional outcomes over the long term. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Enxertos Osso-Tendão Patelar-Osso/transplante , Antebraço/cirurgia , Fraturas do Rádio/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos do Punho/cirurgia , Adulto , Idoso , Avaliação da Deficiência , Articulação do Cotovelo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/complicações , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Traumatismos do Punho/complicações , Articulação do Punho/cirurgia
8.
Eur J Orthop Surg Traumatol ; 28(3): 409-413, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28986647

RESUMO

PURPOSE: Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique. METHODS: Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups. RESULTS: Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred. CONCLUSION: These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction. LEVEL OF EVIDENCE: Therapeutic Level IV.


Assuntos
Traumatismos do Antebraço/cirurgia , Instabilidade Articular/cirurgia , Fraturas do Rádio/cirurgia , Técnicas de Sutura , Adulto , Artroscopia/métodos , Doença Crônica , Feminino , Traumatismos do Antebraço/diagnóstico por imagem , Traumatismos do Antebraço/fisiopatologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Masculino , Membranas/lesões , Membranas/cirurgia , Pessoa de Meia-Idade , Osteotomia/métodos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Suturas
9.
J Bone Joint Surg Am ; 99(14): 1173-1182, 2017 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-28719556

RESUMO

BACKGROUND: The palmaris longus tendon is frequently used as a tendon graft or ligament replacement. In rare instances the median nerve has been inadvertently harvested instead of the palmaris longus for use as a tendon. METHODS: Nineteen cases in which the median nerve had been mistakenly harvested instead of the palmaris longus tendon were collected from members of the American Society for Surgery of the Hand (ASSH) Listserve. Surgeons involved in the subsequent care of the subject who had had an inadvertent harvest were contacted or the chart was reviewed. The reason for the initial procedure, the skill level of the primary surgeon, and when the inadvertent harvest was recognized were documented. When possible, the method of harvest and subsequent treatment were also documented. RESULTS: The most common initial procedure was a reconstruction of the elbow ulnar collateral ligament, followed by basal joint arthroplasty, tendon reconstruction, and reconstruction of the ulnar collateral ligament of the thumb metacarpophalangeal joint. Only 7 of the inadvertent harvests were recognized intraoperatively; in the remaining 12 cases the nerve was used as a tendon graft. The sensory loss was not recognized as being due to the inadvertent harvest until the first postoperative visit (2 subjects), 3 to 4 weeks (2 subjects), 2 to 3 months (2 subjects), 5 to 7 months (2 subjects), 1 year (1 subject), 3 years (1 subject), or 10 years (1 subject). Preoperative clinical identification of the presence or absence of a palmaris longus did not necessarily prevent an inadvertent harvest. CONCLUSIONS: Knowledge of the relevant anatomy is crucial to avoiding inadvertent harvest of the median nerve instead of the palmaris longus tendon.


Assuntos
Nervo Mediano/cirurgia , Erros Médicos , Transferência Tendinosa/efeitos adversos , Tendões/transplante , Adolescente , Adulto , Idoso , Criança , Feminino , Hospitais de Ensino/estatística & dados numéricos , Humanos , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto Jovem
10.
Instr Course Lect ; 66: 103-113, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28594492

RESUMO

Thoracic outlet syndrome is a disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. The characteristics of thoracic outlet syndrome are highly variable. Objective tests, such as electrodiagnostic studies, are often unreliable in characterizing thoracic outlet syndrome. The existence of thoracic outlet syndrome as a discrete entity is controversial. Surgeons who accept the existence of thoracic outlet syndrome acknowledge that diagnosis is clinical. The variability and complexity of thoracic outlet syndrome lends itself to mistakes in both diagnosis and surgical treatment.


Assuntos
Plexo Braquial , Síndrome do Desfiladeiro Torácico , Humanos , Síndrome do Desfiladeiro Torácico/cirurgia
11.
Instr Course Lect ; 66: 141-152, 2017 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-28594494

RESUMO

Carpal tunnel syndrome (CTS) is a focal compressive neuropathy of the median nerve at the level of the wrist. CTS is the most common type of compressive neuropathy that occurs in the upper extremity. Typically, patients with CTS have paresthesia, pain, and numbness in the radial three and one-half digits. Nighttime symptoms are more common earlier in the disease process, with daytime symptoms becoming more frequent as CTS progresses. Electrodiagnostic studies may be performed to confirm a diagnosis of CTS or to obtain a baseline before surgical treatment; however, electrodiagnostic studies may be normal in a subset of patients who have CTS. Patients who have mild CTS should undergo an initial trial of nonsurgical treatment that includes lifestyle modifications, nighttime splinting, and corticosteroid injections. Carpal tunnel release should be performed in patients in whom nonsurgical treatment fails and patients who have acute CTS secondary to infection or trauma or have advanced symptoms. Recalcitrant CTS, which may occur in as many as 25% of patients who undergo carpal tunnel release, most commonly results from an incomplete transverse carpal ligament release or an incorrect initial diagnosis. Patients with recurrent symptoms often have perineural fibrosis that tethers the median nerve.


Assuntos
Síndrome do Túnel Carpal , Síndrome do Túnel Carpal/complicações , Síndrome do Túnel Carpal/cirurgia , Humanos , Nervo Mediano/cirurgia , Dor/etiologia , Punho/cirurgia
13.
Arch Orthop Trauma Surg ; 137(4): 567-572, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28236187

RESUMO

INTRODUCTION: Unstable proximal phalanx fractures are relatively common injuries but consensus of standard treatment is lacking. Outcomes following plate fixation are highly variable, and it remains unclear which factors are predictive for poorer results. The purpose of this study was to compare dorsal and lateral plate fixation of finger proximal phalangeal fractures with regard to factors that influence the outcome. MATERIALS AND METHODS: A retrospective chart review of proximal phalanx fractures treated with dorsal and lateral plating over a 6-year study interval was performed. Demographic data and injury-specific factors were obtained from review of clinic and therapy notes of 42 patients. Fractures were classified based on the OTA classification using preoperative radiographs. Outcomes investigated included final range of motion (ROM) and total active motion (TAM) of all finger joints. Complications and revision surgeries were also analyzed. RESULTS: Fracture comminution, dorsal and a lateral plate position, occupational therapy, and demographic factors did not significantly influence the outcome, complication, and revision rate after plate fixation of finger proximal phalangeal fractures. CONCLUSIONS: Based on the results of this study, no differences in the outcome of finger proximal phalangeal fractures treated by both dorsal and lateral plate fixation were observed. LEVEL OF EVIDENCE: Therapeutic, retrospective comparative, level III.


Assuntos
Placas Ósseas , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas Cominutivas/cirurgia , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/diagnóstico por imagem , Fraturas Cominutivas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Orthop Res Rev ; 9: 101-106, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-30774482

RESUMO

Post-traumatic radioulnar synostosis is a rare complication after forearm or elbow injury that can result in loss of motion and significant disability. Risk factors include aspects of the initial trauma and of the surgical treatment of that trauma. Surgical intervention for synostosis is the standard of care and is determined based on the location of the bony bridge. Surgical timing is recommended between 6 months and 2 years with recent advocacy for the 6- to 12-month period after radiographs demonstrate bony maturation but early enough to prevent further stiffness and contractures. For most types of synostosis, surgical resection with interposition graft is recommended. The types of materials used include synthetic, allograft, and vascularized and non-vascularized materials, but currently there is no consensus on which is the most preferable. Adjuvant therapy is not considered necessary for all cases but can be beneficial in patients with high risk factors such as recurrence or traumatic brain injury. Postoperative rehabilitation should be performed early to maintain range of motion.

15.
Hand (N Y) ; 11(3): 347-352, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27698639

RESUMO

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus number of hand surgeons per capita, and (3) total reimbursement from Medicare versus number of years in practice. Analysis of variance (ANOVA) was used to detect a difference in reimbursement based on categorical range of years as an ASSH member. Results: A total of 1667 ASSH members satisfied inclusion in this study. Although there was significant variation among states' average reimbursement, reimbursement was not significantly correlated with the state's hand surgeons per capita or total number of hand surgeons in that given state. Correlation between years as an ASSH member and average reimbursement was significant but non-linear; the highest reimbursements were seen in surgeons who had been ASSH members from 8 to 20 years. Conclusions: Peak reimbursement from Medicare for ASSH members appears to be related to the time of surgeons' peak operative volume, rather than any age-based bias for or against treating Medicare beneficiaries. In addition, though geographic variation in reimbursement does exist, this does not appear to correlate with density or availability of hand surgeons.


Assuntos
Reembolso de Seguro de Saúde/economia , Medicare , Cirurgiões Ortopédicos/economia , Área de Atuação Profissional/economia , Sociedades Médicas/economia , Análise de Variância , Humanos , Reembolso de Seguro de Saúde/normas , Reembolso de Seguro de Saúde/estatística & dados numéricos , Cirurgiões Ortopédicos/provisão & distribução , Sociedades Médicas/estatística & dados numéricos , Fatores de Tempo , Estados Unidos
16.
J Hand Surg Am ; 41(10): 1019-1026, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27702465

RESUMO

Despite posing a significant public health threat, sleep disorders remain poorly understood and often underdiagnosed and mismanaged. Although sleep disorders are seemingly unrelated, hand surgeons should be mindful of these because numerous conditions of the upper extremity have known associations with sleep disturbances that can adversely affect patient function and satisfaction. In addition, patients with sleep disorders are at significantly higher risk for severe, even life-threatening medical comorbidities, further amplifying the role of hand surgeons in the recognition of this condition.


Assuntos
Mãos/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/terapia , Comorbidade , Feminino , Seguimentos , Mãos/fisiopatologia , Humanos , Masculino , Procedimentos Ortopédicos/métodos , Polissonografia/métodos , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Medição de Risco , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/terapia , Resultado do Tratamento
17.
J Wrist Surg ; 5(3): 184-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27468368

RESUMO

BACKGROUND: The Essex-Lopresti injury results from injuries to the stabilizing structures of the forearm, the radial head, the interosseous membrane, and the triangular fibrocartilage complex. CASE DESCRIPTION/LITERATURE REVIEW: We describe principles in approaching the patient with an acute or chronic Essex-Lopresti injury and describe surgical techniques to address these challenging cases both in the acute and chronic setting and describe outcomes of these techniques. CLINICAL RELEVANCE: Further research into the role of the interosseous ligament in providing longitudinal and transverse stability to the forearm is likely to change our understanding of the Essex-Lopresti injury and alter management strategies.

18.
J Shoulder Elbow Surg ; 25(9): 1491-500, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27374233

RESUMO

BACKGROUND: The purpose of this study was to report outcomes of interosseous membrane (IOM) reconstruction with a suture-button construct for treatment of chronic longitudinal forearm instability. METHODS: We performed a retrospective review with prospective follow-up of patients who underwent ulnar shortening osteotomy and IOM reconstruction with the Mini TightRope device from 2011 through 2014. Bivariate statistical analysis was used for comparison of preoperative and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores, range of motion, grip strength, and ulnar variance. Complications and patient satisfaction were also recorded. RESULTS: Ten patients (mean age, 45.3 years) satisfied inclusion criteria: 8 treated for post-traumatic sequelae of Essex-Lopresti-type injuries, 1 for forearm instability secondary to previous elbow surgery, and 1 for instability secondary to trauma and multiple elbow surgeries. Surgeries were performed an average of 28.6 months from initial injury. At mean follow-up of 34.6 months after surgery, significant improvement was observed in elbow flexion-extension arc (+23° vs. preoperatively; P = .007), wrist flexion-extension arc (+22°; P = .016), QuickDASH score (-48; P = .000), and ulnar variance (-3.3 mm; P = .006). Three patients required additional surgery: 1 revision ulnar shortening osteotomy for persistent impingement, 1 revision ulnar osteotomy and Mini TightRope removal for lost forearm supination, and 1 fixation of a radial shaft fracture after a fall. CONCLUSION: IOM reconstruction using a suture-button construct is an effective treatment option for chronic forearm instability.


Assuntos
Antebraço/fisiopatologia , Membranas/cirurgia , Dispositivos de Fixação Ortopédica , Adulto , Doença Crônica , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Antebraço/cirurgia , Humanos , Masculino , Membranas/lesões , Pessoa de Meia-Idade , Osteotomia , Estudos Prospectivos , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Ulna/cirurgia , Fraturas da Ulna/fisiopatologia , Articulação do Punho/fisiopatologia , Adulto Jovem
19.
J Shoulder Elbow Surg ; 25(4): 681-7, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26803932

RESUMO

BACKGROUND: Medial epicondylectomy (ME) is one of several accepted surgical options for the treatment of cubital tunnel syndrome (CuTS). Although reported outcomes after ME are generally favorable, few data exist regarding which patients are prone to poorer outcomes requiring revision surgery. The goal of this study was to identify risk factors predicting the need for revision surgery after ME for the treatment of CuTS. METHODS: We conducted a retrospective chart review of all patients treated at our institution with ME for CuTS from 2006 through 2011. We identified patients who underwent additional operations for recurrent or persistent ulnar nerve symptoms as the revision cohort. We performed bivariate analysis to determine which variables had a significant influence on the need for revision surgery. We examined qualitative factors associated with revision, including the degree of bony resection performed during the index ME, and intraoperative findings at the time of revision surgery. RESULTS: Revision surgery was required in 13.3% of cases (11 of 83). On bivariate analysis, younger age, associated workers' compensation claims, lesser disease severity, and preoperative opioid use were all significant predictors of the need for revision surgery. Perineural scarring and heterotopic bone formation about the elbow were the 2 most common findings at the time of revision. CONCLUSIONS: For patients with CuTS, the risk of revision surgery after ME is higher in younger patients, patients with less severe disease, patients taking opioid medications preoperatively, and patients with associated workers' compensation claims. LEVEL OF EVIDENCE: Level IV; Case Series; Treatment Study.


Assuntos
Síndrome do Túnel Ulnar/cirurgia , Úmero/cirurgia , Nervo Ulnar/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Descompressão Cirúrgica , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
20.
J Hand Surg Am ; 41(3): 427-35, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26787404

RESUMO

PURPOSE: To determine the incidence of revision and potential risk factors for needing revision surgery following in situ ulnar nerve decompression for patients with idiopathic cubital tunnel syndrome (CTS). METHODS: We conducted a retrospective chart review of all patients treated at 1 specialty hand center with an open in situ ulnar nerve decompression for idiopathic CTS from January 2006 through December 2010. Revision incidence was determined by identifying patients who underwent additional surgeries for recurrent or persistent ulnar nerve symptoms. Bivariate analysis was performed to determine which variables had a significant influence on the need for revision surgery. RESULTS: Revision surgery was required in 3.2% (7 of 216) of all cases. Age younger than 50 years at the time of index decompression was the lone significant predictor of need for revision surgery. Other patient factors, including gender, diabetes, smoking history, and workers' compensation status were not predictive of the need for revision surgery. Disease-specific variables including nerve conduction velocities, McGowan grading, and predominant symptom type were also not predictive of revision. CONCLUSIONS: For patients with idiopathic CTS, the risk of revision surgery following in situ ulnar nerve decompression is low. However, this risk was increased in patients who were younger than 50 years at the time of the index procedure. The findings of this study suggest that, in the absence of underlying elbow arthritis or prior elbow trauma, in situ ulnar nerve decompression is an effective, minimal-risk option for the initial surgical treatment of CTS. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.


Assuntos
Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica , Nervo Ulnar/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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