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1.
Arch Orthop Trauma Surg ; 140(1): 43-50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31486856

RESUMO

INTRODUCTION: Several methods treating proximal interphalangeal joint (PIP) fracture dislocations have been established providing early joint mobilization. The aim of this study was to evaluate the clinical and radiological outcome of unstable fracture dislocations of the PIP treated with a parabolic dynamic external fixator consisting of two Kirschner (K)-wires. MATERIALS AND METHODS: Twenty-one patients who sustained a pilonoidal fracture of the PIP joint and were treated with a dynamic external fixator were evaluated retrospectively. The active range of motion, pain level, DASH score, Buck Gramcko Score, and the patient's satisfaction and acceptance were assessed. X-ray images were evaluated for bone healing, joint alignment, and signs of osteoarthritis. RESULTS: Mean PIP joint range of motion was 76°. Patients showed very mild discomfort (mean 0.7), high patient satisfaction (mean 1.9), and a moderate acceptance (mean 2.7). The mean DASH score was 11.6 and the Buck Gramcko score 13. All patients showed bone healing. One patient suffered from a recurrent dislocation, and another a subluxation of the PIP joint while wearing the fixator. Both joints could be corrected by modifying the fixator under image intensifier. Twenty patients (95%) showed a concentric and stable aligned joint. Three patients showed an osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 according to the Kellgran-Lawrence Score. CONCLUSION: The use of a parabolic dynamic external fixator constructed from two K-wires restores joint alignment and stability in unstable pilonoidal PIP joint disclocation fractures. It allows immediate PIP joint mobilization to avoid adhesions. Modifications of the radius of the parabolic construct within cases of postoperative malalignment, without anesthesia, can restore joint axis and malalignment. This fixator is a cost-effective alternative, showing a good clinical outcome.


Assuntos
Traumatismos dos Dedos , Articulações dos Dedos , Fratura-Luxação , Fixação de Fratura , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Humanos , Estudos Retrospectivos
3.
Tech Hand Up Extrem Surg ; 23(4): 176-181, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31738739

RESUMO

Digital external fixation is often used for the management of complex injuries involving the proximal interphalangeal joint, including pilon fractures of the middle phalanx base and unstable fracture-dislocations. Several dynamic "homemade" constructs have been described which utilize only K-wires and rubber bands and allow early range of motion within the construct. Although these constructs are inexpensive and their application is fairly straightforward, their designs pose a few potential problems when the construct is stressed during rehabilitation efforts. These designs utilize a blocking K-wire which relies on pin-to-pin contact to maintain reduction and creates unnecessary friction that can impede motion and result in pin loosening in bone. Furthermore, rubber band rupture can occur and destabilizes the construct. Here we present a novel technique which utilizes only K-wires and K-wire caps, provides adequate joint distraction and stabilization throughout the arc of motion, and avoids the aforementioned pitfalls of existing designs.


Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Adulto , Fios Ortopédicos , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fluoroscopia , Humanos , Masculino
4.
Bone Joint J ; 101-B(10): 1263-1271, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31564142

RESUMO

AIMS: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires. PATIENTS AND METHODS: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire six months after surgery, with a third of the minimal clinically important difference (MCID) used as the noninferiority threshold. Secondary outcomes were pain, health-related quality of life (EuroQol five-dimensional questionnaire (EQ-5D)), radiological measures, functional deficits, and complications. RESULTS: Overall, 151/290 of patients (52%) completed the six months of follow-up, leaving 83 patients in the single-wire group and 68 patients in the dual-wire group. In the modified intention-to-treat analysis set, mean DASH scores six months after surgery were 3.8 (sd 7.0) and 4.4 (sd 9.4), respectively. With multiple imputation (n = 288), mean DASH scores were estimated at 6.3 (sd 8.7) and 7.0 (sd 10.0). Upper (1 - 2α)) confidence limits consistently remained below the noninferiority margin of 3.0 points in the DASH instrument. While there was a statistically nonsignificant trend towards a higher rate of shortening and rotational malalignment in the single wire group, no statistically significant differences were observed across groups in any secondary outcome measure. CONCLUSION: A single thick K-wire is sufficient for intramedullary fixation of acute displaced subcapital fractures of the fifth metacarpal neck. The less technically demanding single-wire technique produces noninferior clinical and radiological outcomes compared with the dual-wire approach. Cite this article: Bone Joint J 2019;101-B:1263-1271.


Assuntos
Fios Ortopédicos , Fratura-Luxação/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Intramedular de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Ossos Metacarpais/lesões , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Alemanha , Força da Mão/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Ossos Metacarpais/cirurgia , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Amplitude de Movimento Articular/fisiologia , Medição de Risco
5.
J Orthop Sci ; 24(6): 1042-1046, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31495538

RESUMO

BACKGROUND: We proposed a new system named the sagittal, coronal, axial, rotational and fracture (SCARF) classification, which can simply explain any condition of proximal interphalangeal (PIP) joint dislocations of the fingers. The purpose of this study was to verify that this classification would contribute to management of PIP joint dislocations at the initial therapy. We determined ratios of five factors in PIP dislocations with SCARF by interpreting radiographs and assessed the interobserver and intraobserver variability. METHODS: In total, 68 fingers in 67 consecutive patients were studied. The SCARF classification is composed of five factors: (1) sagittal plane displacement is rated by dorsal (D), volar (V), or neutral (N); (2) coronal plane displacement, by ulnar (U), radial (R), or neutral (N); (3) axial force, by compression (C), traction (T), or no (N); (4) rotational displacement, by supine (S), prone (P), or neutral (N); and (5) fracture concomitance, by minus (-) or plus (+). The row of the five characters explains each condition of PIP joint dislocations. Interobserver and intraobserver variability was determined after six orthopedic surgeons independently classified the same radiographs twice. RESULTS: All 68 dislocations were classified into 14 types, unless fracture concomitance was considered. The most common type was DUNN (35%). In coronal plane displacements, the two ulnar fingers showed a higher tendency to the ulnar position. Ring finger fracture concomitance was higher than in middle fingers or little fingers. In interobserver analysis, mean kappa coefficient for each factor was 0.63, 0.75, 0.68, 0.33, and 0.84, respectively. In intraobserver analysis, that was 0.73, 0.79, 0.71, 0.41, and 0.81, respectively. CONCLUSIONS: Even other than hand specialists can specify the type of every PIP dislocation by using the SCARF classification and will have better understanding of the disorder. It would contribute to management of PIP dislocations at the initial therapy. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.


Assuntos
Traumatismos dos Dedos/classificação , Fratura-Luxação/classificação , Luxações Articulares/classificação , Traumatismos dos Dedos/diagnóstico por imagem , Fratura-Luxação/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Radiografia
6.
Hand Surg Rehabil ; 38(5): 317-322, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31386924

RESUMO

While many finger conditions in climbers have been studied extensively, no data exist on the treatment of rock climber's finger flexor tenosynovitis. The purpose of this study was to evaluate the outcomes after corticosteroid injection. The study included rock climbing athletes suffering from chronic (longer than 6 weeks) finger flexor tenosynovitis who were seen at our clinic in 2017. All 42 patients received two corticosteroid injections within a 7-10 day period. Thirty-one climbers (73.8%) were pain free after the second injection and a mean of 20.9±23.1 days. The climbers reported an 84.2% decrease in pain level and no complications. The positive outcome after corticosteroid injection therapy and the absence of complications justifies this invasive approach in rock climbing athletes.


Assuntos
Dexametasona/administração & dosagem , Traumatismos dos Dedos/tratamento farmacológico , Glucocorticoides/administração & dosagem , Injeções , Montanhismo , Tenossinovite/tratamento farmacológico , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Humanos , Masculino , Estudos Prospectivos , Tenossinovite/diagnóstico por imagem , Ultrassonografia , Escala Visual Analógica
7.
AJR Am J Roentgenol ; 213(3): 534-548, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31268729

RESUMO

OBJECTIVE. The purpose of this article is to review the general guidelines for MRI of the finger and emphasize normal finger anatomy as it relates to abnormalities and injuries. CONCLUSION. Advanced imaging, particularly MRI, is increasingly relied on to make the diagnosis and guide management of finger injuries. It is incumbent on radiologists to understand the complex anatomy of the fingers as well as to be familiar with common injuries and aspects of injuries that affect management in order to meaningfully contribute to patient care.


Assuntos
Traumatismos dos Dedos/diagnóstico por imagem , Dedos/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Dedos/anormalidades , Dedos/anatomia & histologia , Humanos
8.
Clin Orthop Surg ; 11(2): 220-225, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31156775

RESUMO

Background: Fracture-dislocation of the proximal interphalangeal (PIP) joint of the finger is challenging due to the high risk of stiffness. The purpose of this study is to evaluate the clinical and radiological results of a modified transosseous wiring technique for the management of chronic fracture-dislocations of the PIP joint. Methods: Ten patients (nine men and one woman; mean age, 38.3 years; range, 21 to 69 years) with neglected fracture-dislocation of the PIP joint were included. The mean duration from injury to operation was 14.7 weeks (range, 3 to 66 weeks). The dorsolateral approach and extension block pinning were used to reduce dislocation. After thorough debridement of the scar tissues in the dorsal dead space and the fracture site, the reduction was maintained with transosseous wiring. Radiologic evaluations of bone union and arthritic changes and clinical evaluations (range of motion of the PIP joint and Disabilities of the Arm, Shoulder and Hand [DASH] score) were performed. The mean follow-up period was 12.9 months (range, 12 to 19 months). Results: All patients demonstrated evidence of radiographic healing within a mean healing time of 6 weeks (range, 4 to 10 weeks); however, one had a widened gap and one had an early arthritic change. The mean range of motion in the PIP joint was 81° (range, 50° to 105°). The mean DASH score was 21.6 (range, 7.5 to 35.8). Conclusions: For chronic fracture-dislocation of the PIP joint, transosseous wiring with direct curettage and optimal bone purchase can provide satisfying outcome.


Assuntos
Fios Ortopédicos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Fratura-Luxação/cirurgia , Fixação Intramedular de Fraturas/métodos , Adulto , Idoso , Desbridamento , Avaliação da Deficiência , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Articulações dos Dedos/diagnóstico por imagem , Fratura-Luxação/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Tempo para o Tratamento
10.
Skeletal Radiol ; 48(12): 1941-1946, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31114969

RESUMO

OBJECTIVE: Flexor tendon repair currently requires extensive exposure to locate and repair tendons. Ultrasound (US) has been used to identify lacerated tendon ends with little information on accuracy. This study was designed to measure the accuracy of US to localize tendon ends in zone II flexor tendon lacerations in a cadaveric model. MATERIALS AND METHODS: US was used to locate tendon ends in zone II lacerations of fingers of six cadaveric hands (96 tendon ends) by a musculoskeletal radiologist. The distance of each tendon end relative to the laceration was recorded. Specimens were dissected and tendon position was compared to US position. RESULTS: The radiologist correctly identified full-thickness lacerations of both superficial and deep tendons 99.0% (n = 05/96 tendons) of the time. The average difference between mean US predicted retraction and anatomic confirmed retraction for all digits all tendons was 3.5 mm of underestimation. US correctly identified the position of all tendon stumps to within 10 mm 92.7% (n = 89/96 tendons) of the time and 69.8% (n = 67/96 tendons) of the time to within 5 mm. Error tended to underestimate (61.5%; 59/96 tendons) rather than overestimate retraction (29.2%; 28/96 tendons). CONCLUSIONS: This fresh cadaveric study has demonstrated that with an experienced radiologist, there was 99.0% accuracy identifying a completed tendon tear and locating the tendon ends with US to within 1 cm was 92.7% accurate.


Assuntos
Traumatismos dos Dedos/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Ultrassonografia/métodos , Cadáver , Humanos
11.
Skeletal Radiol ; 48(9): 1435-1437, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037344

RESUMO

OBJECTIVE: Injuries of the flexor-tendon-pulley system are common in rock climbers. The status of the A3 pulley ligament is crucial for grading such injuries. As standard MRI may miss lesions of the A3 pulley ligament, we introduce a semi-dynamic MRI sequence. MATERIALS AND METHODS: Twenty-two fingers (14 volunteers, 3 injured climbers) were scanned using a sagittal T1 turbo spin echo sequence (repetition time: 400 ms, echo time: 14 ms, slice thickness: 5 mm) in six consecutive finger positions from stretched to maximum possible flexion. RESULTS: No pulley lesion was found in volunteers. Bowstringing was detected in 3 injured fingers including the A3 pulley. CONCLUSION: Semi-dynamic MRI is an technique that is easy to perform to identify injuries of the A3 pulley ligament that were not seen on standard imaging.


Assuntos
Traumatismos dos Dedos/diagnóstico por imagem , Ligamentos/diagnóstico por imagem , Ligamentos/lesões , Imagem por Ressonância Magnética/métodos , Montanhismo/lesões , Traumatismos dos Tendões/diagnóstico por imagem , Feminino , Dedos/diagnóstico por imagem , Humanos , Masculino , Tendões/diagnóstico por imagem
12.
Ulus Travma Acil Cerrahi Derg ; 25(3): 281-286, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31135948

RESUMO

BACKGROUND: Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture. METHODS: Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle's classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford's criteria. RESULTS: Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4-12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5-6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°-80°) and an average extension deficit of 3.84° (range: 0°-15°). According to Crawford's criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up. CONCLUSION: Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.


Assuntos
Traumatismos dos Dedos , Fixação Interna de Fraturas , Fratura Avulsão , Adulto , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/cirurgia , Humanos , Masculino , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(20): e15481, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096445

RESUMO

RATIONALE: Mallet finger fracture is a common sports-related injury that may lead to the tearing of extensor tendon and protrusion of a bony fragment located at the base of the distal phalanx. We affirmed that the elastic fixation of with two K-wires technique is a good method to deal with Mallet Finger fractures that fractures could gain effective fixation than the conventional treatment method and avoid surgical incision complication PATIENT CONCERNS:: We reported a 33-year-old female patient came to our hospital complaining of mild pain, swelling and her right little finger was deformed because of sport's injury. DIAGNOSIS: Acute mallet finger fracture type IV B according to Doyle classification of mallet injuries. INTERVENTIONS: We performed an emergency operation for the elastic fixation of the mallet finger fractures with two K-wires. OUTCOMES: After the surgery, the patient showed functional recovery. No evidence of recurrence was noted 6 months after the operation, and the patient showed no symptoms of sports-related injuries. LESSONS: We discuss the clinical diagnosis, treatment, and follow-up of the patient and suggest that elastic fixation with two K-wires is a good method to treat mallet finger fractures.


Assuntos
Fios Ortopédicos/normas , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/cirurgia , Adulto , Assistência ao Convalescente , Fios Ortopédicos/efeitos adversos , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Humanos , Amplitude de Movimento Articular/fisiologia , Recuperação de Função Fisiológica/fisiologia , Traumatismos dos Tendões/cirurgia , Resultado do Tratamento
15.
Ann Plast Surg ; 82(4): 399-402, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30855367

RESUMO

BACKGROUND: The diaphyseal axis-metacarpal head angle (DHA) measures the angle between the axis of the proximal phalanx and the center of the metacarpal head. In unfractured fingers, the normal DHA ranges from 177.1° to 180.0°. The angle may be used to quantify the degree of lateral displacement of pediatric fractures of the base of the proximal phalanx. Previous authors have shown that if the postreduction x-rays show an angle greater than 169° remodeling with normalization of the DHA is expected to occur in children. The degree of remodeling of more severe angulations is unknown. PATIENTS AND METHODS: This is a retrospective study (over the last 5 years) that identified 8 late referrals (4-6 weeks after injury) of inadequately reduced pediatric fractures of the base of the proximal phalanx with a postreduction DHA of 156° to 163°. At the time of presentation to the author, there was lateral deviation of the finger, and the fracture site was not tender, indicating malunion. All patients were offered surgery, but this was refused by the parents. Follow-up appointments to the clinic were made, and the DHAs were serially measured to investigate the degree of remodeling. RESULTS: Seven patients had normalization of the DHA (ie, an angle >177°) between 9 and 18 months. In the remaining patient, the DHA was 175.7° at 2 years. CONCLUSIONS: The current study shows adequate remodeling of severe residual angular deformities (DHA of 156°-163°). The clinical implication of this finding is regarding late referrals with no tenderness at the fracture site. In these cases, refracturing usually requires general anesthesia. Our study shows that patients may be given the option of conservative management awaiting remodeling.


Assuntos
Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Mal-Unidas/cirurgia , Amplitude de Movimento Articular/fisiologia , Criança , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Consolidação da Fratura/fisiologia , Fraturas Mal-Unidas/diagnóstico por imagem , Força da Mão , Humanos , Masculino , Radiografia/métodos , Recuperação de Função Fisiológica , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Amostragem , Fatores de Tempo
16.
PLoS One ; 14(3): e0213339, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30835766

RESUMO

PURPOSE: To compare the diagnostic performance and raters´confidence of radiography, radiography equivalent dose multi-detector computed tomography (RED-MDCT) and radiography equivalent dose cone beam computed tomography (RED-CBCT) for finger fractures. METHODS: Fractures were inflicted artificially and randomly to 10 cadaveric hands of body donors. Radiography as well as RED-MDCT and RED-CBCT imaging were performed at dose settings equivalent to radiography. Images were de-identified and analyzed by three radiologists regarding finger fractures, joint involvement and confidence with their findings. Reference standard was consensus reading by two radiologists of the fracturing protocol and high-dose multi-detector computed tomography (MDCT) images. Sensitivity and specificity were calculated and compared with Cochrane´s Q and post hoc analysis. Rater´s confidence was calculated with Friedman Test and post hoc Nemenyi Test. RESULTS: Rater´s confidence, inter-rater correlation, specificity for fractures and joint involvement were higher in RED-MDCT and RED-CBCT compared to radiography. No differences between the modalities were found regarding sensitivity. CONCLUSION: In this phantom study, radiography equivalent dose computed tomography (RED-CT) demonstrates a partly higher diagnostic accuracy than radiography. Implementing RED-CT in the diagnostic work-up of finger fractures could improve diagnostics, support correct classification and adequate treatment. Clinical studies should be performed to confirm these preliminary results.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Traumatismos dos Dedos/diagnóstico , Fraturas Ósseas/diagnóstico , Tomografia Computadorizada Multidetectores/métodos , Imagens de Fantasmas , Radiografia/métodos , Traumatismos dos Dedos/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Doses de Radiação
17.
J Pediatr Orthop ; 39(9): e657-e660, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30628978

RESUMO

BACKGROUND: Phalangeal fractures of the hand are common in children, and most extra-articular fractures can be treated with nonoperative management. Minimally or nondisplaced fractures may simply be immobilized, whereas displaced fractures need closed reduction before immobilization. Although few of these fractures displace secondarily, most schemes currently recommend follow-up x-rays after initial diagnosis. Our primary objective was to identify subgroups of finger fractures that are stable, thus requiring no radiographic monitoring. METHODS: This study was designed as a retrospective, single-center analysis of conservatively treated pediatric finger fractures of the proximal and middle phalanges. We included patients up to 16 years with base or shaft fractures of the index to little fingers who underwent nonoperative treatment and standardized follow-up controls in our pediatric hand surgery outpatients' clinic between 2010 and 2016. Fracture angular deformity in x-rays taken at diagnosis and after 1 and 3 weeks were reassessed blinded, and a statistical analysis was conducted to identify fracture types that are prone to secondary angular deformity. RESULTS: A total of 478 patients were eligible; 113 were lost due to missing final radiographic controls. Overall, 365 patients were analyzed; they had a mean age of 9.7 years (range, 1 to 16), and 33.4% required a primary closed reduction. A secondary angular deformity occurred in 2.2% (8/365) of all finger fractures. No secondary angulation occurred in primary minimally and nondisplaced fractures, but 6.6% (8/122) of the reduced fractures showed a subsequent loss of reduction. CONCLUSIONS: Minimally angulated (<10 degrees) and nondisplaced metaphyseal and diaphyseal fractures of proximal and middle phalanges of the index to little fingers are stable and therefore do not need radiographic follow-ups. However, initially angulated fractures requiring closed reduction bear a risk of subsequent loss of reduction. LEVEL OF EVIDENCE: Level III-retrospective study.


Assuntos
Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/diagnóstico por imagem , Adolescente , Traumatismos do Braço , Criança , Pré-Escolar , Traumatismos dos Dedos/cirurgia , Dedos , Seguimentos , Fraturas Ósseas/cirurgia , Humanos , Lactente , Radiografia , Estudos Retrospectivos , Raios X
18.
Plast Reconstr Surg ; 143(1): 176-180, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325897

RESUMO

The purpose of this study was to investigate the clinical outcome of the wide-awake tendon reconstruction for chronic rupture of the flexor pollicis longus tendon with evaluation of the voluntary active contraction distance of the ruptured musculotendinous unit. Eleven consecutive patients underwent tendon reconstruction under wide-awake surgery. If the total of the passive distraction distance and the active contraction distance of the ruptured flexor pollicis longus musculotendinous unit was greater than 30 mm, tendon grafting was performed. If not, tendon transfer was performed using the fourth flexor digitorum superficialis. Patients were evaluated with total active motion before surgery, during surgery, and in final follow-up and subjectively surveyed with quick Disabilities of the Arm, Shoulder and Hand scores. The final outcomes of tendon grafting and of tendon transfer were compared. Tendon grafting was performed in four patients, and tendon transfer was performed in seven patients. The final follow-up total active motion was 84.3 ± 12.7 percent in the tendon transfer group and 80.7 ± 10.2 percent in the tendon grafting group. There were no significant differences between the two groups in the final follow-up total active motion percentage and quick Disabilities of the Arm, Shoulder and Hand scores. The functional outcomes of both tendon grafting and tendon transfer were acceptable based on evaluating the active contraction distance and passive distraction distance of the ruptured musculotendinous unit during wide-awake surgery. Evaluating these distances may be a useful index to assess the ruptured musculotendinous unit. The greatest advantage of the wide-awake tendon reconstruction is that surgeons can evaluate the ruptured musculotendinous unit and measure total active motion during surgery while adjusting suture tension. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Anestesia Local/métodos , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Idoso , Doença Crônica , Estudos de Coortes , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Ruptura/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Transferência Tendinosa/métodos , Vigília
19.
Sportverletz Sportschaden ; 32(4): 251-259, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30537790

RESUMO

RATIONALE AND OBJECTIVES: Pulley ruptures are the most common injuries in sport climbing. Ruptures of the A2 and A4 pulleys have been studied extensively, and ultrasound has proven to be a highly sensitive and specific tool for their diagnosis. However, the correct diagnosis of A3 pulley ruptures continues to be a challenge. Therefore, we investigated a novel approach to this pathology. MATERIAL AND METHODS: Eighteen fingers from nine different human cadavers were examined using high-resolution, dynamic ultrasound before and after being subjected to different combinations of singular and multiple iatrogenic pulley ruptures in a standardised fashion. Special attention was paid to the behaviour of the volar plate (VP) with respect to the proximal interphalangeal joint (PIP) and the flexor tendons before and after pulley rupture. RESULTS: Injuries to the A2 and A4 pulleys were diagnosed via ultrasound with sensitivities of 90 % and 94 % and specificities of 100 % and 97 %, respectively. A direct visualisation of the A3 pulley was achieved in 61 % of the fingers. The VP became significantly thicker and shorter during finger flexion as well as after A3 pulley rupture. The distance between tendon and VP became significantly more pronounced after A3 pulley rupture. For distances greater than 0.9 mm between VP and tendon, a sensitivity of 76 % and a specificity of 94 % were achieved for determining A3 pulley ruptures. CONCLUSION: The distance measurement between VP and tendon was found to be a valid indirect method for the diagnosis of A3 pulley ruptures. This approach is the first ultrasound method for accurately diagnosing A3 pulley ruptures.


Assuntos
Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Tendões/diagnóstico por imagem , Ultrassonografia , Cadáver , Humanos , Ruptura , Tendões
20.
An. sist. sanit. Navar ; 41(3): 387-392, sept.-dic. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-179087

RESUMO

La inyección de alta presión en la mano causa una pequeña lesión cutánea pero severo daño tisular subcutáneo que puede provocar pérdida funcional permanente o amputación. Un tratamiento urgente y adecuado es determinante. Presentamos el caso de un pintor industrial que se inyectó pintura con base de aceite con su pistola de alta presión en el dedo índice izquierdo. Ingresó en Urgencias, donde se le administró profilaxis antitetánica y antibioterapia intravenosa y, antes de transcurridas cuatro horas, se le realizó un desbridamiento quirúrgico. Al año de la lesión el paciente presentaba movilidad activa y pasiva del dedo completa con palidez cutánea, hipersensibilidad y disfunción con la exposición al frío. Hay que reconocer la severidad de estas lesiones con apariencia inicial benigna y realizar un amplio desbridamiento quirúrgico inmediato de todo el tejido isquémico, ya que el retraso en realizarlo se asocia con altas tasas de complicaciones


High-pressure injection into the hand causes a small skin lesion but severe subcutaneous tissue damage, which can result in permanent functional loss or amputation. Urgent and appropriate treatment is decisive. We present the case of an industrial painter who injected oil-based paint with a high-pressure gun into his left index finger. He was admitted to Accidents and Emergencies, where tetanus prophylaxis and antibiotic therapy were administered. Then, within four hours of his arrival at the hospital, the patient was brought to the operating room for surgical debridement. A year after the injury the finger's active and passive range of motion was complete, although paling of the skin together with hypersensitivity and dysfunction occurred on exposure to cold. The severity of these lesions, even if their initial appearance is benign, must be recognized and an immediate surgical debridement of the entire ischemic tissue should be performed, because delay in treatment is associated with higher rates of complication


Assuntos
Humanos , Masculino , Adulto , Pintura/efeitos adversos , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/cirurgia , Rubor/induzido quimicamente , Hipestesia/complicações , Rubor/diagnóstico por imagem , Rubor/cirurgia , Antibioticoprofilaxia , Antibacterianos/uso terapêutico , Administração Intravenosa
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