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1.
Medicine (Baltimore) ; 99(48): e23451, 2020 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-33235132

RESUMO

RATIONALE: Radiocarpal fracture-dislocations are extremely infrequent injuries caused by high-energy trauma and involve significant osseous and ligamentous injuries. If not treated properly, it can lead to serious complications such as ulnar translation of the carpus, multidirectional instability, loss of motion, and post-traumatic arthritis. Purely ligamentous injuries are rarer than fracture-dislocation injuries. Because previous studies have reported small patient cohorts, there has been no standardized treatment strategy for purely ligamentous radiocarpal dislocation. PATIENT CONCERNS: A 24-year-old man suffered a left wrist injury in a motorcycle accident. Plain radiographs revealed dorso-ulnar radiocarpal dislocation without radial fracture and Carpal-ulnar distance ratio (CUDR) was 0.16. MRI scans showed the disruption of the dorsal ligaments and capsules and avulsed from the proximal insertion of the volar radiocarpal ligaments. DIAGNOSIS: Dorsoulnar radiocarpal dislocation with purely ligamentous injury. INTERVENTION: We removed the interposing chondral fragment from the radiocarpal joint and repaired the radioscaphocapitate (RSC) and radiolunate (RL) ligaments with the Jugger Knot Soft Anchor Suture (Biomet, Inc, Warsaw, IN) and applied additional radiocarpal K-wires and an external fixator to maintain reduction and optimal ligament tension. OUTCOMES: The patient showed good clinical results although ulnar translation of the carpus recurred in radiological follow-up. LESSONS: Aggressive surgical management is needed earlier in the treatment of purely ligamentous radiocarpal dislocation, especially if the ulnar translation of the carpus was observed in the initial radiographs.


Assuntos
Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Traumatismos do Punho/cirurgia , Acidentes de Trânsito , Fios Ortopédicos , Fixadores Externos , Humanos , Luxações Articulares/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Imagem por Ressonância Magnética , Masculino , Motocicletas , Radiografia , Âncoras de Sutura , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
2.
Medicine (Baltimore) ; 99(38): e22196, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957349

RESUMO

We report the arthroscopic and clinical findings of patients with chronic wrist pain following distal radius fracture (DRF) who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment.We retrospectively analyzed the records of 15 patients with chronic wrist pain following DRF, who underwent diagnostic arthroscopy and arthroscopically-assisted tailored treatment from 2010 to 2017. The average patient age was 44 years (range, 20-68 years), average time from injury to treatment 21 ±â€Š23.46 months (range, 3-96 months) and average follow up period 20.13 ±â€Š8.71 months (range, 12-39 months). The functional outcome was evaluated by comparing the preoperative and final follow up values of the range of motion, grip strength, pinch strength, visual analogue scale for pain and quick disabilities of the arm, shoulder and hand score.Based on the arthroscopic findings, synovitis was found in all cases and the pathologic intra-articular lesions were classified into 4 patterns. Triangular fibrocartilage complex rupture was seen in 14 cases, intercarpal and radiocarpal ligament ruptures in 9 cases, ulnar impaction syndrome in 5 cases, and cartilage lesion in 9 cases. In terms of surgical treatment, 15 patients underwent arthroscopic synovectomy, 7 foveal or capsular repair of TFCC, 7 intercarpal Kirschner wires fixation or intercarpal thermal shrinkage, 1 intercarpal ligament reconstruction, 2 Sauve-Kapandji procedure, and 2 unlar shortening osteotomy. Postoperatively, the average range of motion, grip strength, and pinch strength increased significantly. From preoperative to final follow up values, the average visual analogue scale and quick disabilities of the arm score decreased from 5.93 ±â€Š1.58 (range, 3-8) to 1.33 ±â€Š1.29 (range, 0-3) (P = .001) and from 49.38 ±â€Š19.09 to 12.63 ±â€Š7.63 (P = .001), respectively.Diagnostic arthroscopy and arthroscopically-assisted tailored treatment of chronic wrist pain following DRF can provide an accurate diagnosis, significant pain relief, and functional improvement.


Assuntos
Artroscopia/estatística & dados numéricos , Dor Crônica/cirurgia , Fraturas do Rádio/complicações , Traumatismos do Punho/cirurgia , Adulto , Idoso , Artroscopia/métodos , Dor Crônica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico , Adulto Jovem
4.
Handchir Mikrochir Plast Chir ; 52(5): 382-391, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32992395

RESUMO

Clinical and radiological diagnostics are the base of a differentiated treatment of carpal disorders. With special regard to diagnostics of the scaphoid, not only the choice and the correct implementation of the imaging methods are crucial, but also their methodical limitations have to be taken into account. No other common fracture is more often undiagnosed, because neglected or overlooked. Concomitantly, delayed or untreated scaphoid fractures require demanding therapies in the sequel and may lead to functional restrictions in the long-term. This review article aims to discuss the clinical and imaging diagnostics for scaphoid fractures and non-union.


Assuntos
Fraturas do Rádio , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Fraturas da Ulna , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Humanos , Articulação do Punho
5.
Handchir Mikrochir Plast Chir ; 52(5): 392-398, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32992396

RESUMO

The aim of the present study is to give an overview over the possibilities of 3D imaging in the analysis of scaphoid fractures and non-unions and to discuss them on the base of case studies and literature.


Assuntos
Fraturas do Rádio , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Fraturas da Ulna , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Humanos , Imageamento Tridimensional
6.
Handchir Mikrochir Plast Chir ; 52(5): 399-403, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32992397

RESUMO

This review article aims to discuss the indications, techniques, outcomes, and complications of non-operative management of scaphoid fractures.


Assuntos
Fraturas do Rádio , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Fraturas da Ulna , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Traumatismos do Punho/terapia , Tratamento Conservador , Humanos
7.
Biomed Environ Sci ; 33(7): 510-517, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32807270

RESUMO

Objective: The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns. Methods: We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018. The clinical and pathological data were extracted from electronic hospital medical records. We obtained follow-up information through clinic visits. Results: The injury sites for all 8 patients were the wrists, specifically 5 right and 3 left wrists, all of which were on the flexor side. Five patients had ulnar artery embolism necrosis and patency, with injury to the radial artery. Two patients had ulnar and radial arterial embolization and necrosis. The last patient had ulnar arterial embolization and necrosis with a normal radial artery. After debridement, the wound area ranged from 12 cm × 9 cm to 25 cm × 16 cm. The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns. Free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) were used to repair the wounds. The prognosis for all patients was good after six months to one year of follow-up. Conclusion: Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice. The use of free flow-through anterolateral thigh flaps (combined with great saphenous vein transplantation if necessary) to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.


Assuntos
Queimaduras por Corrente Elétrica/cirurgia , Retalhos Cirúrgicos/estatística & dados numéricos , Coxa da Perna , Cicatrização , Traumatismos do Punho/cirurgia , Adulto , Pequim , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
8.
J Am Acad Orthop Surg ; 28(15): e670-e678, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732659

RESUMO

Outcomes research has historically been driven by single-center investigations. However, multicenter studies represent an opportunity to overcome challenges associated with single-center studies, including generalizability and adequate power. In hand surgery, most clinical trials are single-center studies, with few having randomized controls and blinding of both participants and assessors. This pervasive issue jeopardizes the integrity of evidence-based practice in the field. Because healthcare payers emphasize applying the best available evidence to justify medical services, multicenter research collaborations are increasingly recognized as an avenue for efficiently generating high-quality evidence. Although no study design is perfect, the potential advantages of multicenter trials include generalizability of the results, larger sample sizes, and a collaboration of experienced investigators poised to optimize protocol development and study conduct. As the era of single-center studies shifts toward investment in multicenter trials and clinical registries, investigators will inevitably be faced with the challenges of conducting or contributing to multicenter research collaborations. We present our experiences in conducting multicenter investigations to provide insight into this demanding and rewarding frontier of research.


Assuntos
Amputação , Artrite Reumatoide/cirurgia , Artroplastia/métodos , Medicina Baseada em Evidências , Dedos/cirurgia , Dedos/transplante , Mãos/cirurgia , Colaboração Intersetorial , Estudos Multicêntricos como Assunto , Satisfação Pessoal , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Reimplante , Silicones , Nervo Ulnar/cirurgia , Traumatismos do Punho/cirurgia , Humanos , Resultado do Tratamento
9.
Pan Afr Med J ; 35: 135, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32655749

RESUMO

Galeazzi fracture is defined as the association of radius fracture and inferior radioulnar joint dislocation. Its diagnosis is often unrecognized initially. The purpose of our study is to determine the epidemioclinical features of Galeazzi fracture-dislocations in adults and to assess the functional and radiological outcomes of our case series. We conducted a retrospective descriptive study of 45 patients with Galeazzi fractures treated surgically whose data were collected in the Department of Orthopaedics at the Habib Bourguiba University Hospital, Sfax, Tunisia, over a period ranging from 2009 to 2018. We used Mestdagh score for the clinical evaluation of the results. The mean time between fracture and treatment initiation was 5.35 days. Fixation of the radius was performed using screwed plate in 39 cases and fixation of the radio-ulnar joint using a plug in 13 cases. The average time for union was 10.5 weeks. Outcomes were excellent in 35 patients, good in 3 patients, medium in 6 patients and adverse in a patient. We had 3 cases of sepsis at the level of the plug and two cases of malunions. Galeazzi fracture-dislocation is an under diagnosed disorder in some cases. Dynamic intraoperative examination after solid fixation of the radius can allow for good functional results.


Assuntos
Fixação Interna de Fraturas/métodos , Luxações Articulares/cirurgia , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Luxações Articulares/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Fraturas do Rádio/diagnóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Tunísia , Traumatismos do Punho/diagnóstico , Adulto Jovem
10.
Medicine (Baltimore) ; 99(28): e21216, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664172

RESUMO

INTRODUCTION: The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site. PATIENT CONCERNS: A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist. DIAGNOSIS: Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis. INTERVENTIONS: The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width. OUTCOMES: After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh. CONCLUSION: ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.


Assuntos
Síndromes Compartimentais/etiologia , Complicações Pós-Operatórias/etiologia , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos , Coxa da Perna/cirurgia , Doença Aguda , Criança , Lesões por Esmagamento/cirurgia , Feminino , Traumatismos da Mão/cirurgia , Humanos , Traumatismos do Punho/cirurgia
12.
Acta Orthop Traumatol Turc ; 54(3): 348-352, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32442125

RESUMO

Acute lunate and perilunate dislocations are not commonly observed injuries. In particular, palmar-divergent dislocation is a very rare injury with only a few cases reported in the literature. In this report, we describe the case of a 37-year-old patient with palmar-divergent dislocation of the scaphoid and lunate and discuss the mechanism of this type of injury. We also report a potential treatment for this pattern of palmar-divergent dislocation. The scapholunate and scaphocapitate joints were stabilized with K-wires and a modified pin-in-plaster fixation for 5 weeks after successful closed reduction. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate. However, radiographs showed mild dorsal intercalated segment instability deformity. The patient experienced no intermittent wrist pain or limitation in motion, with only 15% loss in grip strength. The Mayo wrist score was 90/100, and the patient resumed work as a craftsman. The carpal height ratio at the 4-year follow-up was 1.51 and 1.52 for the left and right wrists, respectively. In conclusion, we recommend this treatment method due to its benefits of being relatively simple, easy to perform, and having a relatively short operation time. Essentially, a good outcome was achieved using this method, including full range of motion and freedom from pain.


Assuntos
Redução Fechada , Dispositivos de Fixação Ortopédica , Osso Escafoide/diagnóstico por imagem , Traumatismos do Punho , Articulação do Punho , Adulto , Redução Fechada/instrumentação , Redução Fechada/métodos , Humanos , Luxações Articulares/fisiopatologia , Luxações Articulares/cirurgia , Osso Semilunar/diagnóstico por imagem , Masculino , Radiografia/métodos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/reabilitação , Traumatismos do Punho/cirurgia , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia
13.
Arch Orthop Trauma Surg ; 140(7): 993-999, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32382940

RESUMO

INTRODUCTION: Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears. MATERIALS AND METHODS: We retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables. RESULTS: The interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson's correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = - 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002). CONCLUSIONS: Children and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases. LEVEL OF EVIDENCE: Level III; Diagnostic.


Assuntos
Instabilidade Articular/diagnóstico por imagem , Fibrocartilagem Triangular , Traumatismos do Punho , Articulação do Punho , Adolescente , Artroscopia , Criança , Humanos , Imagem por Ressonância Magnética , Radiografia , Estudos Retrospectivos , Fibrocartilagem Triangular/diagnóstico por imagem , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/cirurgia , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
14.
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
15.
J Pediatr Orthop ; 40(8): e708-e711, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32251116

RESUMO

BACKGROUND: Scaphoid nonunion in adolescents is rare, and most treatments include prolonged immobilization and screw fixation. Many studies have shown that Kirschner wires (K-wires) show comparable outcomes in screw fixation in adult scaphoid nonunion. However, few studies have reported K-wire fixation results in the treatment of adolescent scaphoid nonunion. The purpose of this study was to evaluate the clinical and radiologic results after bone graft and K-wire fixation for scaphoid nonunion in adolescents. METHODS: We retrospectively reviewed 12 adolescent patients, mean age 15.4 (12 to 17) years, who underwent surgical treatment of scaphoid nonunion. Autogenous bone grafts with K-wire fixation were performed for all patients. Radiologic results, including bone union and degenerative changes, were evaluated with serial radiographs. Clinical results, including range of motion, grip strength, and a visual analogue scale for pain, were assessed. RESULTS: All patients received <3 years of postoperative follow-up assessments. Stable bony union was achieved in all patients. Radiologic bony unions were identified at an average of 11.4 weeks postoperatively (range, 9 to 15 wk). The mean active range of motion of the injured wrist at 3 years postoperatively was 215 degrees (range, 185 to 230 degrees). None of the patients were treated for wrist pain or needed medication during follow-up. Three patients experienced intermittent pain (visual analogue scale 1) after heavy work. The grip strength was reduced compared with the uninjured hand (31.8 and 32.8 kg, respectively), but there was no statistically significant difference (P=0.19). All patients had the K-wire removed at 12 weeks postoperatively. There was no degenerative change in the scaphoid at the final follow-up radiograph. CONCLUSION: Autogenous bone graft with K-wire fixation could be a reliable treatment option of scaphoid nonunion in adolescents. LEVEL OF EVIDENCE: Level IV-retrospective case series.


Assuntos
Transplante Ósseo/métodos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adolescente , Fios Ortopédicos , Criança , Seguimentos , Humanos , Masculino , Radiografia , Amplitude de Movimento Articular , Estudos Retrospectivos , Osso Escafoide/cirurgia , Escala Visual Analógica , Articulação do Punho
16.
Jt Dis Relat Surg ; 31(1): 73-80, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160498

RESUMO

OBJECTIVES: This study aims to compare the single versus double screw fixation of scaphoid waist fractures using finite element analysis, and to present the preliminary clinical results of double screw fixation in a consecutive series of patients with scaphoid nonunion. PATIENTS AND METHODS: A transverse scaphoid waist fracture (Herbert type B2) model was fixed with either single or double cannulated compression screws. Displacement and rotation of the fragments were performed using three-dimensional finite element analysis in three different wrist positions. A retrospective review was performed on 13 male patients (mean age 31.6±12.8 years; range, 17 to 64 years) who underwent double screw fixation for an established scaphoid nonunion in our clinic between January 2015 and December 2017. Assessment of union was established with serial plain radiographs in eight patients and with wrist computed tomography in five patients. Clinical evaluation was performed using the Mayo wrist score and visual analog scale (VAS). RESULTS: In all wrist positions, the displacement of the fracture gap in double screw fixation in all planes (x, y, and z) was less than in single screw fixation. Similarly, rotation of the fracture fragments around the longitudinal axis of the scaphoid was lower in double screw fixation. Complete union was obtained in all patients. The mean time to union was 5±0.75 months (range, 4 to 6 months). The mean VAS was 0.8±0.9 (range, 0 to 3). Mayo wrist score was 91±6.9 (range, 80 to 100) at the final follow-up. CONCLUSION: Double-screw fixation technique may be a solution to reduce the rate of scaphoid nonunion in unstable type B2 scaphoid fractures or nonunion.


Assuntos
Parafusos Ósseos , Fraturas não Consolidadas/cirurgia , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adolescente , Adulto , Análise de Elementos Finitos , Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Osso Escafoide/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Adulto Jovem
17.
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
18.
Bull Hosp Jt Dis (2013) ; 78(1): 81-87, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32144967

RESUMO

Wrist arthroscopy is a useful surgical technique that has been steadily gaining popularity since the 1980s. In addition to being a valuable diagnostic tool, wrist arthroscopy can be used for an expanding array of therapeutic interventions and is an attractive, minimally invasive treatment modality for patients. However, wrist arthroscopy is not without its complications, and a detailed understanding of the relevant anatomy, instrumentation, and methodology is critical for success.


Assuntos
Artroscopia/métodos , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgia , Diagnóstico por Imagem , Humanos , Complicações Pós-Operatórias , Articulação do Punho/anatomia & histologia
19.
Clin Sports Med ; 39(2): 313-337, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115087

RESUMO

The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.


Assuntos
Traumatismos em Atletas/cirurgia , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Traumatismos do Punho/cirurgia , Traumatismos em Atletas/diagnóstico , Humanos , Instabilidade Articular/etiologia , Complicações Pós-Operatórias , Resultado do Tratamento , Traumatismos do Punho/complicações , Traumatismos do Punho/diagnóstico
20.
Clin Sports Med ; 39(2): 373-400, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115090

RESUMO

Ulnar-sided wrist pain is a common problem in athletes that can be challenging owing to its frequent combination of overuse in conjunction with acute injury. Repetitive pronosupination, wrist flexion and extension, as well as radial and ulnar deviation can predispose the athlete to injury of ulnar structures. Careful understanding of the sport-specific injuries as well as the underlying biomechanics are key to understanding and treating the athlete. In this article, we discuss the most frequent causes of ulnar-sided wrist pain in the athlete and focus on anatomy and pathophysiology, presentation, and diagnosis, as well as nonoperative and operative treatment options.


Assuntos
Artralgia/etiologia , Traumatismos em Atletas/diagnóstico , Traumatismos do Punho/diagnóstico , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/terapia , Fenômenos Biomecânicos , Humanos , Cuidados Pós-Operatórios , Amplitude de Movimento Articular , Punho/anatomia & histologia , Punho/fisiologia , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/cirurgia , Traumatismos do Punho/terapia
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