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1.
Ann R Coll Surg Engl ; 102(5): 348-354, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233845

RESUMO

INTRODUCTION: Predicting when fracture incidence will rise assists in healthcare planning and delivery of preventative strategies. The aim of this study was to investigate the relationship between temperature and the incidence of hip and wrist fractures. METHODS: Data for adults presenting to our unit with a hip or wrist fracture over a seven and eight-year period respectively were analysed. Incidence rates were calculated and compared with meteorological records. A Poisson regression model was used to quantify the relationship between temperature and fracture rate. RESULTS: During the respective study periods, 8,380 patients presented with wrist fractures and 5,279 patients were admitted with hip fractures. All women (≥50 years: p<0.001; <50 years: p<0.001) and men aged ≥50 years (p=0.046) demonstrated an increased wrist fracture rate with reduced temperature. Men aged <50 years also had an increased wrist fracture rate with increased temperature (p<0.001).The hip fracture rate was highest in women aged ≥50 years but was not associated with temperature (p=0.22). In men aged ≥50 years, there was a significant relationship between reduced temperature and increased fracture rate (p<0.001). CONCLUSIONS: Fragility fracture of the wrist is associated with temperature. Compared with an average summer, an additional 840 procedures are performed for wrist fractures during an average winter in our trust with an additional 798 bed days taken up at a cost of £3.2 million. The winter increase seen in male hip fracture incidence requires approximately 888 surgical procedures, with 18,026 bed days, and costs £7.1 million. Hip fracture incidence in older women is not related to temperature.


Assuntos
Temperatura Baixa/efeitos adversos , Fraturas do Quadril/epidemiologia , Temperatura Alta/efeitos adversos , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Traumatismos do Punho/epidemiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Fatores de Risco , Estações do Ano , Fatores Sexuais , Traumatismos do Punho/cirurgia , Adulto Jovem
2.
Orthop Clin North Am ; 51(2): 227-233, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138860

RESUMO

Ulnar abutment (ulnocarpal impaction) syndrome may be a source of ulnar-sided wrist pain in the athlete. This condition results from excessive load transfer across the triangular fibrocartilage complex and ulnocarpal joints with characteristic degenerative changes. It frequently occurs in patients with either static or dynamic ulnar positive variance. Treatment is tailored to the athlete and their sporting demands. Surgical treatment focuses on addressing ulnar variance to unload the ulnocarpal joint, with multiple surgical options, including the metaphyseal closing wedge osteotomy achieving this goal. This review focuses on the presentation, biomechanics, and treatment options for ulnar abutment syndrome in the athlete.


Assuntos
Artralgia/terapia , Traumatismos em Atletas/terapia , Mau Alinhamento Ósseo/terapia , Ulna/lesões , Traumatismos do Punho/terapia , Artralgia/complicações , Artralgia/cirurgia , Traumatismos em Atletas/complicações , Traumatismos em Atletas/cirurgia , Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/cirurgia , Humanos , Osteotomia , Ulna/cirurgia , Traumatismos do Punho/complicações , Traumatismos do Punho/cirurgia
4.
Am J Phys Med Rehabil ; 99(4): 285-290, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32195715

RESUMO

OBJECTIVE: Distal radius fractures in the older population significantly impair grip strength. The aim of the study was to investigate whether a hand strength focused exercise program during the period of immobilization for nonoperatively managed distal radius fractures in this population improved grip strength and quality of life. DESIGN: This is a single-center randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty-two patients older than 60 yrs who experienced distal radius fractures managed nonoperatively with cast immobilization. The intervention group (n = 26) received a home hand strength-focused exercise program from 2 and 6 wks after injury while immobilized in a full short arm cast. The control group (n = 26) performed finger range of motion exercises as per protocol. Primary outcome was grip strength ratio of injured arm compared with uninjured arm. Secondary outcome included functional scores of the 11-item shortened version of the Disabilities of the Arm, Shoulder and Hand. Outcomes were measured at 2, 6, and 12 wks after injury. RESULTS: The intervention group significantly improved grip strength ratio at both 6 and 12 wks (6 wks: 40% vs 25%, P = 0.0044, and 12 wks: 81% vs 51%, P = 0.0035). The intervention group improved the 11-item Disabilities of the Arm, Shoulder and Hand score at 12 wks; however, this was not statistically significant (25 vs 40, P = 0.066). CONCLUSIONS: A hand strength-focused exercise program for elderly patients with distal radius fractures while immobilized significantly improved grip strength.


Assuntos
Terapia por Exercício/métodos , Fixação de Fratura/reabilitação , Força da Mão , Fraturas do Rádio/reabilitação , Traumatismos do Punho/reabilitação , Idoso , Moldes Cirúrgicos , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/fisiopatologia , Método Simples-Cego , Resultado do Tratamento , Traumatismos do Punho/fisiopatologia
5.
Medicine (Baltimore) ; 99(8): e19298, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080147

RESUMO

Patients who commit self-wrist cutting injuries (SWCIs) are a heterogeneous group composed of patients with non-suicidal self-injury (NSSI) and suicide attempt (SA). The purpose of this study was to compare the demographic features and wound characteristics of patients with NSSI and SA.A retrospective review of 300 patients who visited the emergency department (ED) for treatment of SWCIs between January 2011 and December 2015 was performed. Data collected from the electronic medical records included age, sex, the reason for SWCIs, presence of suicidal ideation, concomitant intoxication with alcohol or drugs, past psychiatric history, whether or not the patient received psychiatric counseling at the ED, the principal psychiatric diagnosis, the number and severity of external wounds, and subsequent follow-up at the psychiatric or hand surgery outpatient department (OPD). The patients were divided into the NSSI and SA groups according to the presence of suicidal ideation and other variables were compared between the two groups.There were 138 NSSI patients and 162 SA patients. The NSSI group was younger (33.9 years vs 40.9 years, P < .01), more female-dominant, and more non-compliant with psychiatric treatment than the SA group. Compared with the SA group, fewer NSSI patients had past psychiatric histories (26.1% vs 45.7%, P < .01) and more patients refused psychiatric counseling (30.4% vs 9.9%, P < .01) and follow-up at the psychiatric OPD (8.0% vs 17.3%, P < .01). In contrast, the number (P = .31) and severity (P = .051) of wounds and the rate of follow-up at the hand surgery OPD (P = .43) were not statistically different between the two groups.Although the NSSI and SA groups showed different demographic features and degrees of compliance with psychiatric treatment, wound characteristics were not different between the two groups. Therefore, hand surgeons cannot estimate patients' suicidal intent based on wound characteristics and all patients should be advised to receive psychiatric treatment.


Assuntos
Comportamento Autodestrutivo/psicologia , Tentativa de Suicídio/psicologia , Ferimentos Perfurantes/psicologia , Traumatismos do Punho/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Relações Interpessoais , Masculino , Transtornos Mentais/psicologia , Serviços de Saúde Mental , Pessoa de Meia-Idade , Cooperação do Paciente , República da Coreia/epidemiologia , Estudos Retrospectivos , Comportamento Autodestrutivo/epidemiologia , Distribuição por Sexo , Estresse Psicológico/psicologia , Tentativa de Suicídio/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Ferimentos Perfurantes/epidemiologia , Traumatismos do Punho/epidemiologia , Adulto Jovem
6.
AJR Am J Roentgenol ; 214(4): 871, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32045309

RESUMO

OBJECTIVE. The purpose of this article is to show the sonographic anatomy of the extremities relevant to various ligamentous, tendinous, and articular injuries occurring in the hand, wrist, and ankle. A brief discussion and depiction of the specific elements relevant to the pathophysiologic mechanism of these entities is followed by demonstrations of the dynamic ultrasound techniques that can be used to diagnose these injuries. The schematics and video clips illustrate the normal and pathologic features of these injuries. The first two videos discuss soft-tissue injuries to the hand and wrist, and the third addresses ankle injuries. CONCLUSION. After clinical assessment, dynamic ultrasound examination is a useful tool for diagnosing and assessing the degree of severity of several soft-tissue injuries to the extremities, some of which can be detected only during active movement. Familiarity with these specific dynamic techniques will enhance the value of the ultrasound examination.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos da Mão/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Tornozelo/fisiopatologia , Traumatismos da Mão/fisiopatologia , Humanos , Lesões dos Tecidos Moles/fisiopatologia , Traumatismos do Punho/fisiopatologia
7.
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
8.
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
9.
Instr Course Lect ; 69: 331-346, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32017736

RESUMO

This chapter will explore scapholunate ligament injuries with a focus on injury recognition, diagnosis, the natural history, and options for treatment. Treatment is based upon injury factors, patient factors, and surgeon preference. The classification systems in common use will be discussed, and treatment options will be explored, including nonsurgical, arthroscopic, repair, reconstruction, pain relieving measures, and salvage procedures.


Assuntos
Artrite , Osso Semilunar , Osso Escafoide , Traumatismos do Punho , Humanos , Ligamentos Articulares
10.
Am J Forensic Med Pathol ; 41(1): 78-80, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32022760

RESUMO

Investigation of a complex suicide is a challenging task, particularly when the combination of modalities adopted is rare and unplanned. There is often a significant likelihood of labeling the case as a homicide. We present an interesting case of unplanned complex suicide with self-stabbing and head injury resulting from intentionally being struck by a train. There were also hesitation cuts evident over the neck and left wrist. This case highlights the importance of studying the nature and characterization of the wounds, examination of clothes, and examination of the scene to safely conclude the cause and the manner of death.


Assuntos
Traumatismos Craniocerebrais/patologia , Ferrovias , Suicídio Consumado , Ferimentos Perfurantes/patologia , Traumatismos Abdominais/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos do Punho/patologia
11.
Medicine (Baltimore) ; 99(5): e18531, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000361

RESUMO

The aim of the study was to investigate the incidence of low-energy fracture of wrist, hip, and spine and the related risk factors in Chinese populations 50 years or older.This study was a part of the Chinese National Fracture Survey (CNFS) carried out in 8 Chinese provinces in 2015. Data on 154,099 Chinese men and women 50 years or older were extracted from the CNFS database for calculations and analyses. Low-energy fracture was defined as fracture caused by slip, trip, or falls from standing height.A total of 247 patients sustained low-energy fractures in 2014, indicating the incidence rate was 160.3/100,000 person-years, with 120.0 [95% confidence interval (CI), 95.5-144.5] and 213.1(95% CI, 180.7-245.6)/100,000 person-years in men and women, respectively. In men, advanced age, alcohol consumption, residence at second floor or above without elevator, sleep duration <7 h/day, and history of past fracture were identified to be significant risk factors for low-energy fractures. In women, advanced age, living in east region, higher latitude zone (40°N -49.9°N), alcohol consumption, more births, sleep duration <7 h/day, and history of past fracture were identified as significant risk factors. Supplementation of calcium or vitamin D or both was identified to be associated with reduced risk of fracture in women (odds ratio, 0.38; 95% CI, 0.20-0.75), but not in men.These epidemiologic data on low-energy fractures provided updated clinical evidence base for national healthcare planning and preventive efforts in China. Corresponding interventions such as decreasing alcohol consumption and sleep improvement should clearly be implemented. For women, especially those with more births and past history of fracture, routine screening of osteoporosis, and intensive nourishment since menopause should be advocated.


Assuntos
Fraturas do Quadril/epidemiologia , Fraturas da Coluna Vertebral/epidemiologia , Traumatismos do Punho/epidemiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
Int J Sports Med ; 41(3): 168-174, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31952082

RESUMO

The aim of this study was to investigate the risk factors and the incidence of injuries in high-intensity functional training (HIFT) practitioners. A survey was administered to 213 HIFT practitioners. Participants reported the number of injuries, the location of the injuries, and training exposure during the preceding six months and answered questions regarding potential risk factors for injury. We found there were 7.1 injuries for every 1000 hours of training. In addition, we found that individuals with experience in the modality (>2 years) were 3.77 times more likely to be affected by injury when compared with beginner individuals (<6 months) (CI95%=1.59-8.92; p=0.003). When the analysis was performed only for the competitive level, we found that practitioners competing at the national level were 5.69 times more likely to experience an injury than competitors who do not compete (CI95%=1.10-29.54; p=0.038). We also found that the injuries mainly affect the shoulder and lumbar regions. It was possible to conclude that subjects with a higher level of experience in the modality are more likely to be affected by injuries and that the shoulder and lumbar areas are most likely to be injured during HIFT.


Assuntos
Traumatismos em Atletas/epidemiologia , Condicionamento Físico Humano/efeitos adversos , Condicionamento Físico Humano/métodos , Adulto , Lesões nas Costas/epidemiologia , Comportamento Competitivo/fisiologia , Exercício Físico , Feminino , Ginástica/lesões , Humanos , Incidência , Traumatismos do Joelho/epidemiologia , Masculino , Prevalência , Treinamento de Resistência/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Lesões do Ombro/epidemiologia , Traumatismos do Punho/epidemiologia , Adulto Jovem
13.
Br J Radiol ; 93(1106): 20190620, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31573325

RESUMO

CT is a readily available imaging modality for cross-sectional characterization of acute musculoskeletal injuries in trauma. Dual-energy CT provides several additional benefits over conventional CT, namely assessment for bone marrow edema, metal artifact reduction, and enhanced assessment of ligamentous injuries. Winter sports such as skiing, snowboarding, and skating can result in high speed and high energy injury mechanisms; dual-energy CT is well suited for the characterization of those injuries.


Assuntos
Esportes na Neve/lesões , Tomografia Computadorizada por Raios X/métodos , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Doenças da Medula Óssea/diagnóstico por imagem , Edema/diagnóstico por imagem , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/lesões , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Lesões do Quadril/diagnóstico por imagem , Humanos , Imageamento Tridimensional , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Fraturas da Tíbia/diagnóstico por imagem , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
14.
Int J Sports Med ; 41(1): 54-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31747701

RESUMO

This study aimed to investigate exposure adjusted injury incidence rates and profiles associated with training and competition in an elite taekwondo athlete population. 82 athletes were investigated for injuries over a period of 5 years. Individual fight time exposure for training and competition was recorded. The type and location of the injuries were classified and exposure-adjusted injury incidence rates (IIR) were calculated per 1000 h for training and competition. 66 athletes with a mean age of 19.3±4.2 years and 172 injuries were included in the final data assessment. The exposure adjusted IIR was significantly higher during competition (p<0.001) with a rate ratio of 6.33 (95% CI 4.58-8.69). Ankle and foot region as well as hand and wrist were most affected with significant higher IIR in competition (p<0.001). Joint injuries, fractures, and bruising occurred the most. Fractures occurred mainly to the hand and wrist region. Future investigations should focus on exposure adjusted injury data including analyses of the detailed mechanism leading to especially severe injuries to improve specific injury prevention in competition and promote evolution of protective gear.


Assuntos
Traumatismos em Atletas/epidemiologia , Comportamento Competitivo/fisiologia , Artes Marciais/lesões , Condicionamento Físico Humano/efeitos adversos , Adolescente , Adulto , Traumatismos do Tornozelo/epidemiologia , Feminino , Traumatismos do Pé/epidemiologia , Traumatismos da Mão/epidemiologia , Humanos , Incidência , Masculino , Estudos Prospectivos , Traumatismos do Punho/epidemiologia , Adulto Jovem
15.
Orthop Clin North Am ; 51(1): 65-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739880

RESUMO

Surgical strategies for scaphoid nonunions become more complex based on time from injury to treatment. The decision-making process, however, can follow a logical sequence. Scaphoid nonunions less than 1 year after trauma and no carpal malalignment can be treated with percutaneous screw fixation under fluoroscopic and/or arthroscopic guidance. Reinterventions or patients with avascular proximal poles that do not need substantial grafts are reliably treated with pedicle vascularized bone grafts. Resection of the distal pole of the scaphoid is a good option in old nonunions or after a failed scaphoid procedures. When there are radioscaphoid degenerative changes, salvage procedures such as proximal row carpectomy (PRC) should be considered.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osteonecrose/cirurgia , Osso Escafoide/lesões , Artroscopia/métodos , Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/classificação , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Osteonecrose/epidemiologia , Osteonecrose/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Estudos Retrospectivos , Osso Escafoide/irrigação sanguínea , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/patologia , Resultado do Tratamento , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem
16.
Orthop Clin North Am ; 51(1): 77-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31739882

RESUMO

Scapholunate ligament injuries are common and can lead to a predictable pattern of arthritis (scaphoid lunate advanced collapse wrist) if unrecognized or untreated. This article describes the relevant anatomy, biomechanics, and classification system, and provides an up-to-date literature-based review of treatment options, including acute repair and various reconstruction techniques. It also helps guide surgeons in making decisions regarding a systematic treatment algorithm for these injuries.


Assuntos
Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos do Punho/complicações , Artrite/epidemiologia , Artrite/etiologia , Fenômenos Biomecânicos , Articulações do Carpo/lesões , Articulações do Carpo/patologia , Articulações do Carpo/cirurgia , Humanos , Ligamentos Articulares/anatomia & histologia , Osso Semilunar/lesões , Osso Semilunar/patologia , Osso Semilunar/cirurgia , Radiografia/métodos , Amplitude de Movimento Articular , Osso Escafoide/lesões , Osso Escafoide/patologia , Osso Escafoide/cirurgia , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/patologia , Articulação do Punho/cirurgia
17.
Emerg Med Clin North Am ; 38(1): 61-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757255

RESUMO

Injury patterns of the hand and wrist can be complex and challenging for the emergency physician to diagnose and treat. The ability of the hand to perform delicate maneuvers requires a very intricate interplay of bones, ligaments, and tendons. Unfortunately, due to the omnipresence of the hand, the hand and wrist are commonly injured. These injuries can be debilitating if not treated correctly and can be both time-consuming and fraught with medicolegal risk. This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas , Traumatismos da Mão , Procedimentos Ortopédicos/métodos , Radiografia , Traumatismos do Punho , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/terapia , Saúde Global , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Humanos , Incidência , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/terapia
18.
Medicine (Baltimore) ; 98(52): e18429, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876721

RESUMO

RATIONALE: Galeazzi fractures are uncommon, and are less common in children than in adults. Galeazzi-equivalent fractures, a variant of the classic Galeazzi fractures, mostly occur in children or adolescents. Galeazzi equivalent fractures may commonly accompany distal radial fractures or injury of the epiphyseal plate of the distal ulna. PATIENT CONCERNS: A 13-year-old man visited our emergency department after stumbling over a rock. Manual reduction and splinting was already done in a nearby medical center. Plain radiographs revealed fractures in the distal radius and fracture of the ulnar epiphyseal plate. DIAGNOSIS: Plain radiographs showed Galeazzi-equivalent fracture. The result of primary closed reduction was not enough and there was still displacement of fracture. INTERVENTIONS: Anatomical reduction of distal radius was fixed with a plate and screws, and K-wires were inserted percutaneously for reduction and fixation of ulnar fracture. OUTCOMES: Complete bone union was achieved and normal range of motion is shown 2 years postoperatively. The patient is able to perform daily activities and sport activities without any signs of ulnar growth arrest. LESSONS: Open reduction is required in patients with malalignment, failure to reduce the DRUJ or maintain its reduction, or older ages which are hard to expect sufficient bone remodeling.


Assuntos
Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Traumatismos do Punho/cirurgia , Acidentes por Quedas , Adolescente , Humanos , Masculino , Redução Aberta/métodos , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/patologia , Fraturas da Ulna/diagnóstico por imagem , Fraturas da Ulna/patologia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/patologia
19.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 353-360, dic. 2019. []
Artigo em Espanhol | LILACS | ID: biblio-1057060

RESUMO

Objetivo: Determinar si los resultados clínicos y radiográficos difieren después del tratamiento conservador y el tratamiento quirúrgico para las fracturas de la estiloides cubital asociadas a fracturas inestables del radio distal tratadas mediante placa volar bloqueada. Materiales y Métodos: Estudio multicéntrico, retrospectivo y descriptivo que incluye pacientes operados en cuatro instituciones, entre 2009 y 2012. Todos tenían fracturas de la estiloides cubital en el contexto de una fractura del radio distal. Las fracturas de la estiloides cubital fueron tratadas de forma conservadora (grupo I) o con cirugía (grupo II). Resultados: El seguimiento promedio fue de 56 meses. Se evaluó a 57 pacientes; grupo I (29 casos) y grupo II (28 casos). Los pacientes del grupo II tuvieron 2,76 veces (IC95% 1,086; 8,80) más posibilidades de lograr una consolidación que aquellos del grupo I. El puntaje DASH y el dolor, tanto en reposo como en actividad, no presentaron diferencias significativas (p = 0,276 y p = 0,877). La desviación cubital y la fuerza obtuvieron mejores resultados en el grupo I (p = 0,0194 y p = 0,024). Conclusiones: Aunque los pacientes con estabilización quirúrgica de la estiloides cubital tuvieron 2,76 más posibilidades de lograr la consolidación que aquellos del grupo I, no hubo diferencias significativas en la evaluación subjetiva (DASH y dolor) entre ambos grupos. Tampoco hubo diferencias significativas cuando se consideró el grado de compromiso de la estiloides cubital, pero la fuerza y la desviación cubital presentaron mejores resultados en el grupo sin fijación de la estiloides cubital. Nivel de Evidencia: III


Objectives: To evaluate potential differences in clinical and radiological outcomes after surgical versus conservative management of ulnar styloid fractures associated with unstable distal radius fractures treated by locked volar plating. Materials and Methods: This was a multicenter, retrospective and descriptive study including surgical patients treated at four different institutions between 2009 and 2012 for ulnar styloid fractures associated with unstable distal radius fractures. Ulnar styloid fractures were treated conservatively in group I and surgically in group II. Results: The average follow-up was 56 months. The study included 57 patients divided into two groups (group I [29 cases] and group II [28 cases]). Patients in group II had 2.76 times (95% CI: 1.086; 8.80) more chances of achieving bone union than those in group I. DASH and pain scores, both at rest and during activity, did not show significant differences between the two groups (p = 0.276 and p = 0.877). Group I presented milder ulnar deviation and better strength (p = 0.0194 and p = 0.024). Conclusions: Although patients who underwent surgery for ulnar styloid fractures had 2.76 more chances of achieving bone union than those who received conservative management, there were no significant differences between both groups in subjective evaluations (DASH and pain scores) or when considering the degree of ulnar styloid involvement. However, the parameters of strength and ulnar deviation were better in the conservative management group. Level of Evidence: III


Assuntos
Adulto , Fraturas do Rádio/cirurgia , Fraturas do Rádio/terapia , Fraturas da Ulna/cirurgia , Fraturas da Ulna/terapia , Traumatismos do Punho , Seguimentos , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(48): e18186, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770273

RESUMO

RATIONALE: Most pediatric distal radius fractures are effectively treated nonoperatively; however, operative intervention is indicated in patients with open and highly unstable fractures, in those with concomitant neurovascular injuries and in patients whom soft tissue interposition between fracture fragments precludes anatomical reduction. Notably, soft tissue interposition between fracture fragments is diagnostically challenging. Surgeons must be mindful of this rare complication for early detection and prompt treatment. PATIENT CONCERNS: A 14-year-old boy presented to the emergency department with left wrist pain after falling from a bicycle. Plain radiography and computed tomography revealed a displaced Smith fracture, which was irreducible by closed reduction, necessitating open reduction and volar plate fixation. The patient reported inability to extend his thumb at his 6-week postoperative follow-up visit. DIAGNOSIS: Ultrasonography showed extensor pollicis longus (EPL) tendon entrapment near the fracture site. INTERVENTIONS: A second operation was performed 10 weeks after the first surgery, and intraoperative exploration revealed EPL tendon entrapment. The EPL tendon was torn to shreds; therefore, extensor indicis proprius tendon transfer was performed for EPL tendon reconstruction. OUTCOMES: The patient's thumb motion was completely restored after the second operation. LESSENS: EPL tendon entrapment in a pediatric Smith fracture is rare. Signs of EPL tendon entrapment include inability to perform active thumb extension, dorsal wrist pain radiating along the course of the EPL tendon, which is exacerbated by thumb flexion, a tenodesis effect elicited on thumb examination, and difficulty in anatomical fracture reduction. Surgical exploration of the EPL tendon is warranted in patients presenting with any of these signs following attempted reduction of a Smith fracture.


Assuntos
Redução Aberta , Fraturas do Rádio , Encarceramento do Tendão , Transferência Tendinosa/métodos , Traumatismos do Punho , Adolescente , Placas Ósseas , Fratura-Luxação/diagnóstico , Fratura-Luxação/cirurgia , Humanos , Masculino , Redução Aberta/efeitos adversos , Redução Aberta/instrumentação , Redução Aberta/métodos , Radiografia/métodos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Reoperação/métodos , Encarceramento do Tendão/diagnóstico , Encarceramento do Tendão/etiologia , Encarceramento do Tendão/cirurgia , Polegar/fisiopatologia , Resultado do Tratamento , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/cirurgia
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