Carpometacarpal Joint Dislocations: Management and Long-Term Outcomes at a Specialized Hand Surgery Center in Latin America.

Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.

Les dislocations des articulations carpométacarpiennes sont des blessures peu courantes de la main. Elles sont généralement mal diagnostiquées en raison de leurs signes cliniques non spécifiques et ont tendance à être difficiles à dépister au moyen d'une simple radiographie. Les auteurs rendent compte de leur expérience dans la prise en charge des dislocations des os carpométacarpiens dans un centre spécialisé de chirurgie de la main. Les patients atteints d'une dislocation carpométacarpienne vus à l'urgence entre 2013 et 2017 étaient inclus dans l'étude. Tous les patients ont subi une réduction fermée et un embrochage percutané (RFEP) ou une réduction ouverte et une fixation interne (ROFI). L'évaluation fonctionnelle postopératoire a eu lieu au bout de six et 18 mois au moyen du score d'incapacité du bras, de l'épaule et de la main (DASH). Onze patients ont participé : huit (72 %) ont subi une RFEP et les autres ont dû subir une ROFI (28 %). Le score DASH moyen du résultat fonctionnel s'établissait à 27,9 au seuil de six mois et à 1,5 à celui de 18 mois. Puisque les dislocations carpométacarpiennes sont rares et faciles à mal diagnostiquer, le chirurgien de la main devrait en présumer la possibilité chez les patients victimes d'un traumatisme de forte énergie, et les études d'imagerie devraient faire l'objet d'une évaluation approfondie. La RFEP est une possibilité de traitement sécuritaire et efficace qui donne de bons résultats fonctionnels à long terme.

Association between DASH diet (Dietary Approaches to Stop Hypertension) and hypertension in adolescents: A cross-sectional school-based study.

BACKGROUND & AIMS: The DASH diet (Dietary Approaches to Stop Hypertension) is considered a healthy dietary pattern, and is recommended for the control of arterial hypertension (AH). However, its role in the adolescent population needs to be better investigated and clarified. The aim of this study is to identify the association between AH and the DASH diet score in a representative sample of Brazilian adolescents. METHODS: A cross-sectional study using data from a national, multicenter and schoolbased probabilistic sample of 71,553 Brazilian adolescents who had their blood pressure (BP) measured and completed a 24-hour dietary recall (2013-2014). The components of the DASH score were assessed. Logistic regression models were used to evaluate the association between AH, anthropometric and sociodemographic variables, and the tertile of the DASH score. RESULTS: Approximately 11% of the adolescents who were in the 3rd tertile of the DASH score presented AH, 18% were overweight and 9% were obese. Among the components of the score, the highest intake was sugar-sweetened beverages (92.1%), legumes and oilseeds (68.2%), red and processed meat (64.5%) and the lowest were low-fat dairy (2.2%), whole grains (11.6%) and fruits (18.1%). Sodium intake was above the maximum recommended in all tertiles. CONCLUSIONS: A small proportion of Brazilian adolescents consume foods from the DASH diet. No associations were found between this dietary pattern and AH. Strategies to increase the intake of protective foods in adolescents must be investigated as well as the potential health benefits of the standard DASH diet for this age group over time.

Rehabilitación temprana de fracturas de mano con órtesis robóticas. Reporte de caso / Early rehabilitation of hand fractures with robotic orthosis. Case report

Introducción El presente estudio de casos revela los avances tecnológicos en el tratamiento de las fracturas de mano realizados por el grupo de investigación F-CIBER-HAND en Manizales, Colombia; integra la intervención quirúrgica practicada por el cirujano ortopedista de mano, la movilización temprana indicada por Fisiatría, la rehabilitación convencional por fisioterapeuta especializada en Ortopedia y Traumatología, y la terapia de movilización pasiva mediante ortesis robóticas. Materiales y métodos Se seleccionaron cuatro pacientes: paciente con fractura intraarticular compleja de la cabeza del quinto metacarpiano de la mano derecha; paciente con fractura conminuta de la base del cuarto metacarpiano de la mano izquierda; paciente con fractura diafisiaria del quinto metacarpiano de la mano derecha, y paciente con fractura subcapital del segundo metacarpiano de la mano izquierda, los cuales fueron tratados de acuerdo con los cuatro momentos terapéuticos descritos, con seguimiento de su evolución clínica individual. Resultados En todos los pacientes se ponen de manifiesto la recuperación funcional de la mano según la Escala de Discapacidades del Hombro, el Codo y la Mano (DASH), la disminución de la intensidad del dolor según la Escala Visual Análoga del Dolor (EVA) y la recuperación del arco de movilidad articular; además, todos los pacientes retornaron a las actividades de la vida diaria y laborales. Discusión Se concluye que con el manejo quirúrgico especializado y la rehabilitación temprana complementada con ortesis robóticas, se mejoró la funcionalidad de la mano, disminuyó el dolor, hubo ganancia del arco articular y reinserción a las actividades cotidianas. El propósito del estudio es generar evidencia clínica de que el manejo interdisciplinario especializado y el uso de ortesis robóticas mejora la condición clínica de los pacientes con fracturas de la mano. Nivel de evidencia clínica nivel IV.

Background The present cases study reveals technological advances in the treatment of hand fractures performed by the F-CIBER-HAND research group in Manizales - Colombia, integrating the surgical intervention by Hand Orthopedic Surgeon, early mobilization Indicated by Physiatry, the conventional rehabilitation by Physiotherapist specialized in Orthopedics and Traumatology, and passive mobilization therapy whit robotic orthoses. Materials and methods Four patients were selected: patient with complex intra-articular fracture in the head of the 5th right metacarpal, patient with a fracture in the base of the 4th left metacarpal, patient with diaphyseal fracture of the 5th right metacarpal, and patient with subcapital fracture of the 2nd left metacarpal, who were treated according to the four therapeutic moments described, with follow-up of their individual clinical evolution. Results In all patients was evident functional recovery of the hand according to the DASH scale, decrease of pain intensity according to analogous visual scale, and recovery of the joint mobility arc. In addition, all the patients returned satisfactorily to the daily life activities and jobs. Discussion It was concluded that with specialized surgical management and early rehabilitation complemented with robotic orthoses, the functionality of the hand was improved, pain decreased, there was gain of the articular arch and reinsertion to daily activities. The purpose of the study is to generate clinical evidence that specialized interdisciplinary management and the use of robotic orthoses improve the clinical condition of patients with hand fractures. Evidence level IV.