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5.
Medicine (Baltimore) ; 98(47): e17649, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764770

RESUMO

RATIONALE: We studied the feasibility of total arathyroidectomy(tPTX)+multi-point transplantation in the forearm for treatment of secondary hyperparathyroidism. Considering the controversial nature of the appropriate timing for and location of this type of surgery, relevant research is relatively rare. Our experience may be a relatively successful one. PATIENT CONCERNS: Our patient was a 28-year-old woman with end-stage renal disease (ESRD), who was on dialysis for 7 years, and a 2-year history of progressively aggravated bone pain. She also had hypercalcemia and hyperphosphatemia. DIAGNOSES: Given the patient's history of long-term dialysis, bone pain, high levels of intact parathyroid hormone(i-PTH) and hypercalcemia, we performed ultrasonography which showed solid nodules in the bilateral parathyroid glands. She was accordingly diagnosed with SHPT. INTERVENTIONS: The patient underwent tPTX+multi-point subcutaneous transplantation in the forearm. OUTCOMES: Her i-PTH level dropped to < 300 pg/mL, and the symptoms of bone pain markedly reduced after surgery. LESSONS: Total parathyroidectomy+multi-point subcutaneous transplantation in the forearm may be a reliable surgical approach for patients with ESRD.


Assuntos
Hiperparatireoidismo Secundário/cirurgia , Glândulas Paratireoides/transplante , Paratireoidectomia , Adulto , Estudos de Viabilidade , Feminino , Antebraço/cirurgia , Humanos , Hiperparatireoidismo Secundário/etiologia , Falência Renal Crônica/complicações , Paratireoidectomia/métodos
6.
J Surg Oncol ; 120(8): 1446-1449, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31733073

RESUMO

Pharyngoesophageal stenosis (PES) is a common and serious complication of head and neck cancer treatments such as radiation therapy, chemotherapy, tracheoesophageal puncture placement, and total laryngectomy surgery. Dilation-resistant stenosis requires surgical reconstruction, often with a radial forearm free flap (RFFF). With the present technique, the authors refine their previous bipaddled free flap design used to reconstruct a persistent tracheoesophageal fistulae (TEF) in combination with PES. Accordingly, we present a novel bipaddled triangular RFFF design ideally suited to address the shape of the defect in the posterior tracheal wall that results when the TEF is opened and the esophageal and tracheal components are restored.


Assuntos
Constrição Patológica/cirurgia , Estenose Esofágica/cirurgia , Antebraço/cirurgia , Retalhos de Tecido Biológico , Doenças Faríngeas/cirurgia , Fístula Traqueoesofágica/cirurgia , Constrição Patológica/etiologia , Estenose Esofágica/etiologia , Feminino , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Pessoa de Meia-Idade , Doenças Faríngeas/etiologia , Fístula Traqueoesofágica/etiologia
8.
Medicine (Baltimore) ; 98(44): e17726, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689814

RESUMO

The purpose of this study was to assess the efficacy and safety of Pelnac and split-thickness skin graft for management of complex wound with underlying bone/tendon exposure at forearm and hand.This is a prospective study, beginning from March 2013 up to May 2017. There were 13 patients, with age of 31.2 years. All of them underwent the staged Pelnac and split-thickness skin graft to manage the complex wound with bone/tendon. Postoperatively, scheduled follow-up was conducted.The average follow-up was 15 months. There were no infections, wound necrosis, hematoma, or seroma during the phase when Pelnac was applied. There was 100% "take" of the Pelnac in 12/13 patients. In 11 patients, there was complete skin graft "take". Patients' satisfaction for the esthetic appearance of the grafted area was 75.0 ±â€Š8.5/100. The VSS value was 2.9 ±â€Š2.5. Regarding the sensory recovery, the response of "normal or near normal" could be obtained in 7/13 patients, "slight loss" in 5 patients and "significant loss" in 1 case. The average DASH score was 27.2 ±â€Š18.5, and most patients (12/13) could obtain an acceptable ability to perform the daily activities.Pelnac dermal template is a favorable alternative to flap reconstruction in the treatment of complex wound with underlying tissues exposure.


Assuntos
Traumatismos do Braço/cirurgia , Regeneração Tecidual Guiada/métodos , Traumatismos da Mão/cirurgia , Transplante de Pele/métodos , Tendões/cirurgia , Adolescente , Adulto , Traumatismos do Braço/fisiopatologia , Derme/fisiopatologia , Derme/cirurgia , Feminino , Seguimentos , Antebraço/cirurgia , Mãos/cirurgia , Traumatismos da Mão/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Retalhos Cirúrgicos , Resultado do Tratamento , Cicatrização/fisiologia , Adulto Jovem
9.
J Hand Surg Asian Pac Vol ; 24(4): 491-493, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690199

RESUMO

We present a case of compartment syndrome of the forearm following harvesting of a full thickness skin graft from the medial forearm for a double digit dermofasciectomy. The patient underwent forearm fasciectomy followed by multiple surgical debridements. At 18 months, despite intensive physiotherapy, the patient was left with a very significant residual functional deficit. This case highlights a previously undescribed but devastating complication of closure of a forearm skin graft donor site.


Assuntos
Síndromes Compartimentais/cirurgia , Fasciotomia/efeitos adversos , Antebraço/cirurgia , Complicações Pós-Operatórias , Transplante de Pele/efeitos adversos , Adulto , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Humanos , Masculino , Doenças Raras , Ultrassonografia
10.
J Hand Surg Asian Pac Vol ; 24(4): 483-487, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690203

RESUMO

We report a case of a symptomatic forearm deformity due to a premature distal ulnar fracture solved by 3D custom made cutting guides. Our patient is a sixteen years old girl referred to us due to a forearm deformity and a dysplasic ulnar head associated to pain at the dorsum of the distal ulna and at the radial head at the elbow. Using custom-made cutting guides on a 3D model, a both bone forearm osteotomy was performed. At 18 months of follow up, the range of motion did not improve significantly but our patient referred no pain and she was satisfied with the procedure. The accuracy of single cut osteotomies, utilizing three-dimensional planning and custom patient guides has been previously established. This technique helped with the pain in our case.


Assuntos
Antebraço/diagnóstico por imagem , Imageamento Tridimensional , Osteotomia/métodos , Radiografia , Fraturas da Ulna/diagnóstico , Ulna/diagnóstico por imagem , Adolescente , Feminino , Antebraço/cirurgia , Humanos , Amplitude de Movimento Articular , Ulna/cirurgia , Fraturas da Ulna/fisiopatologia , Fraturas da Ulna/cirurgia
11.
Acta Clin Croat ; 58(Suppl 1): 18-22, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741554

RESUMO

Introduction: Brachialis plexus block is a frequently used method of regional anesthesia that can be performed in several ways and locations. It has been successfully performed to provide good anesthesia and analgesia lasting several hours for operative procedures on hands. It can be performed by paresthesia technique or by ultrasound that has almost pushed out the old conventional technique since it allows the visualization of the blockade performance. Target: In the paper we use our sample to try to determine which of the two locations of the blockageis more favorable for the patient, and which one gives a higher percentage of success or a better sensory blockade. Method: This is a retrospective study and includes 40 patients of both sexes that were operated on at the Clinic for Traumatology and the Clinic for Plastic Surgery of the University Clinical Center in Sarajevo in the period from 30 August 1993 to 30 August 1994. Patients were divided into two groups. Group I were patients who had an axillary approach to plexus brachialis (n-21) ASA I-II. Group II were patients who had supraclavicular access to plexus brachialis (n-19) ASA I-II. All patients received 0.5 ml / kg Bupivacaine 0.5%. In the study, we analyzed sex, age, duration of blockade and complications. Analgesia and motor block were evaluated 20 minutes after the local anesthetic injection. The complete block is defined as analgesia in all dermatomes (C5-Th1) 20 minutes after injection. The results: Group I had 20 male and 1 female patients while group II had 17 male and 2 female patients. The supraclavicular block enabled complete blockade in 18 patients (95.23%), and the axillary approach had a successful blockade in 17 patients (80.95%). In both groups the corresponding motor block was similar. The start of the engine block was similar in both groups. There were no significant complications in either group. Conclusion: Regarding clinical efficacy, both brachial plexus blocking approaches provided a good motor block, anesthesia and analgesia for the forearm or hand surgery. Supraclavicular approach proved to be more favorable.


Assuntos
Anestesia Local/métodos , Anestésicos Locais , Bloqueio do Plexo Braquial/métodos , Bupivacaína , Adulto , Idoso , Analgesia , Axila , Feminino , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
12.
BMJ Case Rep ; 12(9)2019 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-31501177

RESUMO

The damages caused by high-pressure injuries are often underestimated. Such incidents are characterised by a small punctiform entry wound and the normal colour of skin. The internal damage caused by these injuries can be severely devastating in nature. These injuries required emergent surgical debridement and irrigation. Postoperatively intensive physiotherapy is required for the successful return of hand function. The final functional outcome depends on the initial latency to treatment, nature of injected material, location and volume of injection and postoperative physiotherapy.


Assuntos
Desbridamento , Compostos Férricos , Corpos Estranhos/terapia , Traumatismos da Mão/terapia , Traumatismos Ocupacionais/terapia , Modalidades de Fisioterapia , Pressão , Ferimentos Penetrantes/terapia , Adulto , Analgésicos/uso terapêutico , Antibacterianos/uso terapêutico , Fasciotomia , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Corpos Estranhos/diagnóstico por imagem , Mãos/diagnóstico por imagem , Mãos/cirurgia , Traumatismos da Mão/diagnóstico por imagem , Humanos , Masculino , Traumatismos Ocupacionais/diagnóstico por imagem , Radiografia , Contenções , Irrigação Terapêutica , Técnicas de Fechamento de Ferimentos , Ferimentos Penetrantes/diagnóstico por imagem
13.
J Craniofac Surg ; 30(7): 2085-2087, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31490442

RESUMO

INTRODUCTION: Currently, vascularized autologous bone transplantation is considered the gold standard for large mandibular continuity defect reconstruction. Donor site morbidity is a major concern. Therefore, bone tissue engineering (BTE) seems to be the ideal solution. Fresh-frozen bone allograft is the closest material to autologous bone. The purpose of this clinical report is to show a new technique of large mandibular continuity defect reconstruction using a fresh-frozen humeral allograft seeded with autologous iliac bone marrow aspirate and vascularized with a radial forearm flap. METHODS: A 33-year-old man presented with severe cranio-facial trauma resulting in several fractures of the facial skeleton including a comminuted mandibular fracture from left parasymphysis to left angle, which caused a large continuity defect. RESULTS: Result at 6 months was aesthetically and functionally satisfactory with osseointegration of the bone graft. DISCUSSION: The authors chose to use iliac bone marrow aspirate to seed the allograft scaffold since hematopoietic stem cells and mesenchymal stem cell are able to differentiate into osteoblasts, ease of harvest of the iliac crest and its low rate of morbidity. Contemporary biomaterials used for BTE are bioceramic but bone is still the better scaffold to engineer bone and only allografting avoids donor site morbidity. Vascularization is one of the main challenges of BTE; insertion of autologous vascular bundles from pedicle or free flaps is 1 solution. The authors chose the radial forearm flap since the pedicle is long and the authors did not need a great amount of soft tissue.


Assuntos
Medula Óssea , Úmero/cirurgia , Adulto , Transplante Ósseo/métodos , Antebraço/cirurgia , Retalhos de Tecido Biológico , Humanos , Ílio/transplante , Masculino , Mandíbula/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Engenharia Tecidual , Transplante Homólogo
14.
Acta Chir Orthop Traumatol Cech ; 86(4): 290-293, 2019.
Artigo em Eslovaco | MEDLINE | ID: mdl-31524592

RESUMO

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.


Assuntos
Fíbula/transplante , Traumatismos do Antebraço/cirurgia , Gangrena Gasosa/cirurgia , Fraturas do Rádio/cirurgia , Transferência Tendinosa/métodos , Fraturas da Ulna/cirurgia , Transplante Ósseo , Fíbula/irrigação sanguínea , Antebraço/irrigação sanguínea , Antebraço/cirurgia , Traumatismos do Antebraço/terapia , Fraturas Expostas/cirurgia , Fraturas Expostas/terapia , Gangrena Gasosa/terapia , Humanos , Masculino , Transplante Autólogo
15.
J. bras. nefrol ; 41(3): 330-335, July-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1040248

RESUMO

Abstract Introduction: Arteriovenous fistulas (AVF) are the best hemodialysis vascular accesses, but their failure rate remains high. Few studies have addressed the role of the vascular surgeon's skills and the facility's practices. We aimed to study these factors, with the hypothesis that the surgeon's skills and facility practices would have an important role in primary failure and patency rates at 12 months, respectively. Methods: This was a single-center, prospective cohort study carried out from March 2005 to March 2017. Only incident patients were included. A single surgeon made all AVFs, either in the forearm (lower) or the elbow (upper). Vascular access definitions were in accordance with the North American Vascular Access Consortium. Results: We studied 113 AVFs (65% lower) from 106 patients (39% diabetics, 58% started with catheter). Time to first connection was 21.5 days (IR: 14 - 31). Only 14 AVFs (12.4%) underwent primary failure and 18 failed during the first year. Functional primary patency rate was 80.9% (SE 4.1) whereas primary unassisted patency rate, which included PF, was 70.6% (4.4). Logistic regression showed that diabetes (OR = 3.3, 95%CI 1.38 - 7.88, p = .007) and forearm location (OR = 3.03, 95CI% 1.05 - 8.76, p = 0.04) were predictors of AVF failure. Patency of lower and upper AVFs was similar in non-diabetics, while patency in diabetics with lower AVFs was under 50%. (p = 0.003). Conclusions: Results suggest that a long-lasting, suitable AVF is feasible in almost all patients. The surgeon's skills and facility practices can have an important role in the long term outcome of AVF.


Resumo Introdução: Fístulas arteriovenosas (FAV) são os melhores acessos vasculares para hemodiálise, mas sua taxa de falhas permanece alta. Poucos estudos abordaram o papel das habilidades do cirurgião vascular e das práticas hospitalares. Nosso objetivo foi avaliar esses fatores, com a hipótese de que as habilidades do cirurgião e as práticas hospitalares teriam um papel importante nas taxas de falhas primárias e perviedade em 12 meses, respectivamente. Métodos: Este foi um estudo de coorte prospectivo de um único centro, realizado de março de 2005 a março de 2017. Apenas os pacientes incidentes foram incluídos. Um único cirurgião fez todas as FAVs, seja no antebraço (inferior) ou no cotovelo (superior). As definições de acesso vascular estavam de acordo com o Consórcio Norte-Americano de Acesso Vascular. Resultados: Estudamos 113 FAVs (65% inferiores) de 106 pacientes (39% diabéticos, 58% começaram com cateter). O tempo até a primeira conexão foi de 21,5 dias (RI: 14 - 31). Apenas 14 FAV (12,4%) tiveram falha primária e 18 falharam durante o primeiro ano. A taxa de patência funcional primária foi de 80,9% (SE 4,1), enquanto a taxa de permeabilidade primária não assistida, que incluiu FP, foi de 70,6% (4,4). A regressão logística mostrou que o diabetes (OR = 3,3, 95% IC 1,38 - 7,88, p = 0,007) e localização no antebraço (OR = 3,03, 95% IC 1,05 - 8,76, p = 0,04) foram preditores de falha da FAV. A patência das FAVs inferior e superior foi semelhante em não-diabéticos, enquanto a perviedade em diabéticos com FAV inferior foi menor que 50%. (p = 0,003). Conclusões: Nossos resultados sugerem que uma FAV duradoura e adequada é viável em quase todos os pacientes. As habilidades do cirurgião e das práticas hospitalares podem ter um papel importante no resultado a longo prazo da FAV.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Grau de Desobstrução Vascular , Derivação Arteriovenosa Cirúrgica , Competência Clínica , Cirurgiões , Instalações de Saúde , Estudos Prospectivos , Seguimentos , Diálise Renal/métodos , Falha de Tratamento , Diabetes Mellitus , Cotovelo/cirurgia , Antebraço/cirurgia , Falência Renal Crônica/terapia
16.
Rev. bras. cir. plást ; 34(3): 423-427, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047173

RESUMO

Introdução: Lesões que acometem as mãos com importante perda cutânea frequentemente requerem retalhos para cobertura precoce, visto que permitem melhor reabilitação. Dentre as opções, o retalho interósseo posterior reverso do antebraço é o mais utilizado para defeitos no dorso da mão e punho, com baixas taxas de complicações. Normalmente, esse retalho não é utilizado para a reconstrução de defeitos em região palmar, já que geralmente não alcança esse local. Relato de caso: Apresentamos o caso de um paciente com queimadura elétrica de terceiro grau, em palma da mão direita, cuja reconstrução foi realizada com o uso do retalho interósseo posterior reverso do antebraço, após debridamentos conservadores, no 14o dia após a queimadura. O paciente apresentou boa evolução pós-operatória, sem complicações ou sequelas funcionais a longo prazo. Conclusão: O retalho interósseo posterior reverso do antebraço permite cobertura adequada de lesões em palma da mão, preservando sua funcionalidade.


Introduction: Lesions affecting the hands with significant skin loss often require flaps for early coverage, as these permit faster healing. Among the various options, the reverse posterior interosseous flap of the forearm is most commonly used for defects involving the back of the hand and wrist due to low complication rates. Normally, this flap is not used for the reconstruction of defects in the palmar region since its distal reach is insufficient. Case report: We present the case of a male patient with third-degree electrical burns on his right palm, whose reconstruction was performed on the 14th day postinjury using the reverse posterior interosseous flap of the forearm after conservative debridement. The patient presented good postoperative evolution, without long-term complications or functional sequelae. Conclusion: The reverse posterior interosseous flap of the forearm permits adequate coverage of palm injuries, preserving its functionality.


Assuntos
Humanos , Masculino , Adulto , História do Século XXI , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Operatórios , Retalhos Cirúrgicos , Ferimentos e Lesões , Queimaduras , Queimaduras por Corrente Elétrica , Técnicas de Fechamento de Ferimentos , Antebraço , Traumatismos do Antebraço , Mãos , Traumatismos da Mão , Complicações Intraoperatórias , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/reabilitação , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/reabilitação , Retalhos Cirúrgicos/efeitos adversos , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/reabilitação , Queimaduras por Corrente Elétrica/cirurgia , Queimaduras por Corrente Elétrica/complicações , Técnicas e Procedimentos Diagnósticos , Técnicas de Fechamento de Ferimentos/reabilitação , Antebraço/cirurgia , Traumatismos do Antebraço/cirurgia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/reabilitação , Mãos/cirurgia , Traumatismos da Mão/cirurgia
17.
Gynecol Endocrinol ; 35(12): 1043-1049, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31373236

RESUMO

Transplantation of cryopreserved ovarian tissue offers patients a chance to preserve fertility during cancer treatment. In this study of ten young women with gynecological cancer, heterotopic sites were tested for serum hormones and follicle growth to estimate transplant longevity and prospects for assisted conception. Frozen-thawed grafts were implanted subcutaneously in the forearm (FA) (2 cases), the abdominal wall (AW) (11 cases), and the peritoneal lining (P) (3 cases) . In the follow-up of 36 months, a total of 80 ovarian cycles in different heterotopic sites were analyzed. FA and AW grafts had wildly fluctuating FSH, while estradiol (E2) reached preovulatory levels only in AW and P grafts. Follicular growth was active in P sites (1.2 ± 0.1 mm/d) and sluggish in FA and AW sites (0.4 ± 0.1 mm/d). A mature oocyte was only retrieved from the AW, while seven other aspirations were unsuccessful. Meanwhile, a patient delivered twice after treatment for Hodgkin's lymphoma when orthotopic transplantation was performed, first from an IVF cycle and subsequently from a natural cycle. In conclusion, these findings offer no strong encouragement for fertility preservation by transplanting cryopreserved ovarian tissue to subcutaneous sites, and although the peritoneal site gave better results, graft longevity averaged the same at around 3 years.


Assuntos
Parede Abdominal/cirurgia , Neoplasias do Endométrio/terapia , Preservação da Fertilidade/métodos , Antebraço/cirurgia , Ovário/transplante , Peritônio/cirurgia , Neoplasias do Colo do Útero/terapia , Adulto , Criopreservação/métodos , Estradiol/metabolismo , Feminino , Hormônio Foliculoestimulante/metabolismo , Sobrevivência de Enxerto , Humanos , Folículo Ovariano , Ovário/metabolismo , Transplante Autólogo , Transplante Heterotópico , Adulto Jovem
18.
Medicine (Baltimore) ; 98(28): e16353, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305426

RESUMO

To review our institutional results and assess different surgical and non-surgical techniques for the treatment of displaced diametaphyseal forearm fractures in children and adolescents.Thirty-four children (25M, 9F) with a total of 36 diametaphyseal forearm fractures who underwent treatment under general anesthesia between July 2010 and February 2016 were recruited to this retrospective study. From October 2016 until March 2018 patients and/or parents were contacted by telephone and interviewed using a modified Pediatric Outcomes Data Collection Instrument (PODCI).Median age at the time of injury was 9.1 years (range, 1.9-14.6 years). Initial treatment included manipulation under anesthesia (MUA) and application of plaster of Paris (POP) (n = 9), elastic stable intramedullary nailing (ESIN) (n = 10), percutaneous insertion of at least one Kirschner wire (K-wire) (n = 16), and application of external fixation (n = 1). Eleven children (32%) experienced a total of 22 complications. Seven complications were considered as major, including delayed union (n = 1) and extensor pollicis longus (EPL) tendon injury (n = 1) following ESIN, as well as loss of reduction (n = 2) and refractures (n = 3) after MUA/POP. The median follow-up time was 28.8 months (range, 5.3-85.8 months). In 32 out of 34 cases (94%) patients and/or parents were contacted by telephone and a PODCI score was obtained. Patients who experienced complications in the course of treatment had a significantly lower score compared with those whose fracture healed without any sequelae (P = .001). There was a trend towards an unfavorable outcome following ESIN compared with K-wire fixation (P = .063), but not compared with POP (P = .553). No statistical significance was observed between children who were treated initially with a POP and those who had K-wire fixation (P = .216).There is no standard treatment for displaced pediatric diametaphyseal forearm fractures. Management with MUA/POP only is associated with an increased refracture rate. Based on our experience K-wire fixation including intramedullar positioning of at least one pin seems to be favorable compared with ESIN.


Assuntos
Traumatismos do Antebraço/terapia , Fraturas Ósseas/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Traumatismos do Antebraço/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
20.
Acta Orthop Traumatol Turc ; 53(4): 313-317, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155303

RESUMO

Malignant glomus tumors (MGTs) are exceptional but pose diagnostic and therapeutic challenges. Wide resection is the recommended treatment method, however, no data are available concerning adjuvant therapies. We present an exceptional case of extradigital deep-seated MGT of the forearm, with an exceptional bone infiltration. Despite being treated with wide resection, the patient had an optimal functional outcome, no functional loss, no motor or sensitive deficits and has returned to his full daily activity.


Assuntos
Neoplasias Ósseas , Dissecação/métodos , Antebraço , Tumor Glômico , Neoplasias de Tecidos Moles , Ulna , Atividades Cotidianas , Neoplasias Ósseas/patologia , Neoplasias Ósseas/secundário , Terapia Combinada/métodos , Antebraço/diagnóstico por imagem , Antebraço/patologia , Antebraço/cirurgia , Tumor Glômico/patologia , Tumor Glômico/fisiopatologia , Tumor Glômico/cirurgia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Radiografia/métodos , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/fisiopatologia , Neoplasias de Tecidos Moles/cirurgia , Resultado do Tratamento , Carga Tumoral , Ulna/lesões , Ulna/patologia
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