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BACKGROUND: Germline mutations in the BRCA1 and BRCA2 genes have significant clinical implications for both risk-reducing and early surveillance management. The third and most recent revision of the Manchester scoring system (MSS3) used to distinguish patients indicated for germline BRCA1/2 testing included further adjustments for triple negative breast cancer, high-grade serous ovarian cancer and human epidermal growth factor 2 (HER2) receptor status. This study aims to evaluate the relative effectiveness of MSS3 in a Southeast Asian population. METHODS: All patients in our centre were tested using next-generation sequencing (NGS) panels that included full gene sequencing as well as coverage for large deletions/duplications in BRCA1/2. We calculated MSS1-3 scores for index patients between 2014 and 2017 who had undergone BRCA1/2 genetic testing and recorded their genetic test results. MSS1-3 outcomes were compared using receiver operating characteristic analysis, while associations with predictors were investigated using Fisher's exact test and logistics regression. Calculations were performed using Medcalc17. RESULTS: Of the 330 included patients, 47 (14.2%) were found to have a germline mutation in BRCA1 or BRCA2. A positive HER2 receptor was associated with a lower likelihood of a BRCA1/2mutation (OR=0.125, 95% CI 0.016 to 0.955; P=0.007), while high-grade serous ovarian cancer was conversely associated with an increased likelihood of a BRCA1/2 mutation (OR=5.128, 95% CI 1.431 to 18.370; P=0.012). At the 10% threshold, 43.0% (142/330) of patients were indicated for testing under MSS3, compared with 35.8% (118/330) for MSS1% and 36.4% (120/330) for MSS2. At the 10% threshold, MSS3 sensitivity was 91.5% and specificity 65.0%, significantly better than the previous MSS1 (P=0.037) and MSS2 (P=0.032) models. CONCLUSION: Our results indicate that the updated MSS3 outperforms previous iterations and relative to the Manchester population, is just as effective in identifying patients with BRCA1/2 mutations in a Southeast Asian population.
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Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias de la Mama/diagnóstico , Neoplasias Ováricas/diagnóstico , Adulto , Anciano , Asia Sudoriental/epidemiología , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Femenino , Pruebas Genéticas , Mutación de Línea Germinal/genética , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/genética , Neoplasias Ováricas/patología , Valor Predictivo de las PruebasRESUMEN
BACKGROUND: The combined latissimus dorsi-serratus anterior-rib (LD-SA-rib) free flap provides a large soft-tissue flap with a vascularized bone flap through a solitary vascular pedicle in a one-stage reconstruction. METHODS: Seven LD-SA-rib free flaps were performed in seven patients to reconstruct concomitant bone and extensive soft-tissue defects in the lower extremity (tibia, five; femur, one; foot, one). The patients were all male, with an average age of 34 years (range, 20-48 years). These defects were secondary to trauma in five patients and posttraumatic osteomyelitis in two patients. RESULTS: All flaps survived and achieved bony union. The average time to bony union was 9.4 months. Bone hypertrophy of at least 20% occurred in all flaps. All patients achieved full weight-bearing ambulation without aid at an average duration of 23.7 months. Two patients developed stress fractures of the rib flap. There was no significant donor site morbidity, except for two patients who had pleural tears during harvesting of the flap. CONCLUSION: The LD-SA-rib flap provides a large soft-tissue component and a vascularized bone flap for reconstruction of composite large soft-tissue defects with concomitant bone defects of the lower extremity in a one-stage procedure.
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Fracturas Óseas/cirugía , Colgajos Tisulares Libres , Traumatismos de la Pierna/cirugía , Osteomielitis/cirugía , Adulto , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Periostio/irrigación sanguínea , Radiografía , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/cirugía , Soporte de Peso , Adulto JovenRESUMEN
PURPOSE: To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. METHODS: We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. RESULTS: The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. CONCLUSIONS: Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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Placas Óseas , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/instrumentación , Luxaciones Articulares/cirugía , Inestabilidad de la Articulación/cirugía , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Tornillos Óseos , Estudios de Cohortes , Femenino , Traumatismos de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/cirugía , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Fuerza de la Mano , Humanos , Puntaje de Gravedad del Traumatismo , Luxaciones Articulares/diagnóstico por imagen , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pronóstico , Radiografía , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
The distally based posterior tibial adipofascial flap is a useful option for distal leg and ankle coverage. Traditionally, its dimension is constrained by a length-to-width ratio of 2:1. We have increased this ratio to 4:1 by including the great saphenous vein and saphenous nerve with the flap. These structures with their venoneural network, and their connections with posterior tibial artery perforators, form the vascular axis of the flap. In our series of 21 flaps, 70% (n = 15) had ratios of 3:1 or higher. In remaining 30% (n = 6), the ratio was 2:1, as the defects were more proximal. Complications include one complete flap loss due to compression from tunneling and one superficial tip necrosis. Postoperatively, we performed wet-to-wet dressings, phlebotomy, and delayed skin grafting to optimize flap survival. Of 21 flaps, 20 were healthy after an average follow-up of 24 months.
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Traumatismos de la Pierna/cirugía , Procedimientos de Cirugía Plástica/métodos , Vena Safena/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/inervación , Arterias Tibiales/cirugía , Adulto , Traumatismos del Tobillo/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tibia/irrigación sanguíneaRESUMEN
PURPOSE: To retrospectively review the outcomes of intra-articularly placed interfragmentary screws for fixation of difficult condylar fractures of the metacarpal and proximal phalangeal heads. METHODS: We placed interfragmentary screws intra-articularly in 10 patients with 11 fractures to achieve a rigid fixation construct in which the non-articular portion of the bone fragment is too small to allow a stable fixation, or where the bone fragment is entirely osteochondral. RESULTS: The mean duration of follow-up was 15.9 months (range, 6-45 mo). All fractures united within 16 weeks (average, 8.1 wk). We observed subsidence in 1 case; another patient had screw protrusion that required removal. The range of motion of the involved metacarpophalangeal joints for the metacarpal head fractures was 79° (range, 60° to 90°). The range of motion of the involved proximal interphalangeal joints for the proximal phalangeal head fractures was 86° (range, 80° to 90°). CONCLUSIONS: Intra-articularly placed interfragmentary screw fixation is a good technique for treating difficult condylar fractures of the hand.
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Tornillos Óseos , Traumatismos de los Dedos/cirugía , Fijación Interna de Fracturas/instrumentación , Fracturas Intraarticulares/cirugía , Adolescente , Adulto , Estudios de Cohortes , Femenino , Traumatismos de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/cirugía , Fijación Interna de Fracturas/métodos , Curación de Fractura/fisiología , Humanos , Puntaje de Gravedad del Traumatismo , Fracturas Intraarticulares/diagnóstico por imagen , Masculino , Articulación Metacarpofalángica/lesiones , Articulación Metacarpofalángica/cirugía , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular/fisiología , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Adulto JovenRESUMEN
The latissimus dorsi (LD) flap is a large and reliable myocutaneous flap with a consistently long vascular pedicle. However, the limitation of the thoracodorsal pedicle is that it has only one draining vein for anastomosis. We describe a simple technique of recruiting the tributary vein to the serratus anterior and using it as a second draining vein to alleviate congestion in lower limb reconstruction. The serratus anterior venous tributary segment is cut back to an avalvular segment which averages 5 mm in length. Provision of an additional venous outflow to the flap enabled a second venous anastomosis to the short saphenous vein (N = 1), the long saphenous vein (N = 2), a deep vein (N= 1), and to a deep vein via a vein graft (N = 1), respectively. Five patients with degloving injury of the lower extremity of sizes 150 cm(2) (10 × 15 cm) to 260 cm(2) (10 × 26 cm) underwent successful reconstruction using the LD muscle flap with the serratus anterior tributary vein as a second outflow vein. This serratus anterior venous tributary serves as a useful second outflow channel for alleviating venous congestion during lower limb reconstructive surgery and should be routinely preserved as a lifeboat.
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Traumatismos de los Pies/cirugía , Colgajos Tisulares Libres/irrigación sanguínea , Procedimientos de Cirugía Plástica/métodos , Venas/cirugía , Adulto , Estética , Femenino , Humanos , Complicaciones Posoperatorias/prevención & control , Trombosis de la Vena/prevención & controlRESUMEN
We present a case of a man who sustained a closed dorsal fracture-dislocation of his left ring finger proximal interphalangeal joint in a fall. The patient was treated surgically with plate and screw fixation via a volar approach. This method theoretically provides more secure fixation than internal fixation with screws alone, allowing early rehabilitation with active range of motion and potentially better functional outcome.
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Traumatismos de los Dedos/cirugía , Articulaciones de los Dedos/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Adulto , Placas Óseas , Tornillos Óseos , Terapia por Ejercicio , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/rehabilitación , Articulaciones de los Dedos/diagnóstico por imagen , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , RadiografíaRESUMEN
BACKGROUND: Sclerosing epithelioid fibrosarcoma (SEF) is a very rare soft tissue sarcoma subtype. Clinically it is an aggressive tumour; however, to our knowledge there are no published reports regarding the efficacy of chemotherapy in SEF. Therefore, the aim of this study was to document the outcome of a series of patients with SEF treated at a single referral centre with reference to systemic therapy. METHODS: A retrospective search of a prospectively maintained database was performed to identify all patients diagnosed with SEF between 1990 and 2017. The diagnosis was confirmed in each case by a dedicated soft tissue sarcoma pathologist. We analysed those with recurrent disease and the effect of systemic chemotherapy in the metastatic setting. RESULTS: Thirteen patients were identified, median overall survival from diagnosis and metastasis were 47.3 (95% CI 25.0-131.9) and 16.3 (95% CI 5.3-20.6) months, respectively. In total, 12 (92.3%) patients developed metastatic disease of which 10 died of disease, 1 was lost to follow-up and 1 had recently commenced palliative treatment. Among the 10 patients with metastatic disease, 7 received palliative chemotherapy. Palliative chemotherapy resulted in partial response in 1 patient, stable disease in 3 patients and progressive disease in 3 patients. Median time to disease progression was 2.7 (95% CI 1.2-4.4) months. Two of 13 patients were treated with adjuvant chemotherapy, receiving 6 cycles of liposomal doxorubicin and 1 cycle of doxorubicin, respectively, with a metastasis-free survival of 28.2 and 7.1 months, respectively. CONCLUSION: SEF is an aggressive sarcoma subtype with a poor outcome and with limited responsiveness to conventional chemotherapy. Patients with this subtype should be considered for participation in clinical trials with novel agents. Further investigation into the biology of this rare disease is required to improve outcomes.
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Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Fibrosarcoma/diagnóstico por imagen , Fibrosarcoma/tratamiento farmacológico , Adulto , Anciano , Antineoplásicos/administración & dosificación , Femenino , Fibrosarcoma/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Sarcoma/diagnóstico por imagen , Sarcoma/tratamiento farmacológico , Sarcoma/mortalidad , Tasa de Supervivencia/tendencias , Resultado del TratamientoRESUMEN
Peripheral blood indices of systemic inflammation such as the neutrophil-lymphocyte ratio (NLR) have been shown to be prognostic in various cancers. We aim to investigate the clinical significance of these indices in patients with soft tissue sarcoma (STS). Seven hundred and twelve patients with available blood counts at diagnosis and/or metastatic relapse were retrospectively examined. An optimal cutoff for NLR-high (>2.5) in predicting overall survival (OS) was determined using receiver operating curve analyses. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional models. Our results show that NLR was significantly higher in patients with distant metastasis at diagnosis (n = 183) compared to those without (n = 529) (median: 4.36 vs 2.85, p < 0.0001). Progression of localized disease at diagnosis to metastatic relapse within the same patients was associated with an interval increase in NLR (median: 3.21 vs 3.74, p = 0.0003). In multivariate analysis, NLR-high was the only consistent factor independently associated with both worse OS (HR 1.53, 95% CI 1.10-2.13, p = 0.0112) and relapse-free survival (HR 1.41, 95% CI 1.08-1.85, p = 0.0125) in localized disease, as well as OS (HR 1.82, 95% CI 1.16-2.85, p = 0.0087) in metastatic/unresectable disease. In conclusion, high NLR is an independent marker of poor prognosis among patients with STS.
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Recuento de Leucocitos , Linfocitos , Neutrófilos , Sarcoma/sangre , Sarcoma/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Comorbilidad , Femenino , Humanos , Recuento de Linfocitos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Recuento de Plaquetas , Pronóstico , Curva ROC , Sarcoma/mortalidad , Análisis de Supervivencia , Adulto JovenRESUMEN
Assessment of cancer predisposition syndromes (CPS) in childhood tumours is challenging to paediatric oncologists due to inconsistent recognizable clinical phenotypes and family histories, especially in cohorts with unknown prevalence of germline mutations. Screening checklists were developed to facilitate CPS detection in paediatric patients; however, their clinical value have yet been validated. Our study aims to assess the utility of clinical screening checklists validated by genetic sequencing in an Asian cohort of childhood tumours. We evaluated 102 patients under age 18 years recruited over a period of 31 months. Patient records were reviewed against two published checklists and germline mutations in 100 cancer-associated genes were profiled through a combination of whole-exome sequencing and multiplex ligation-dependent probe amplification on blood-derived genomic DNA. Pathogenic germline mutations were identified in ten (10%) patients across six known cancer predisposition genes: TP53, DICER1, NF1, FH, SDHD and VHL. Fifty-four (53%) patients screened positive on both checklists, including all ten pathogenic germline carriers. TP53 was most frequently mutated, affecting five children with adrenocortical carcinoma, sarcomas and diffuse astrocytoma. Disparity in prevalence of germline mutations across tumour types suggested variable genetic susceptibility and implied potential contribution of novel susceptibility genes. Only five (50%) children with pathogenic germline mutations had a family history of cancer. We conclude that CPS screening checklists are adequately sensitive to detect at-risk children and are relevant for clinical application. In addition, our study showed that 10% of Asian paediatric solid tumours have a heritable component, consistent with other populations.
RESUMEN
BACKGROUND: Pheochromocytomas and paragangliomas (PPGLs) are neuroendocrine tumors of the adrenal glands and paraganglia, occurring sporadically or as a range of hereditary tumor syndromes. About 30% of PPGLs are attributed to germline mutations. Clinical presentation, including localization, malignant potential, and age of onset, varies depending on the genetic background. Genetic testing for PPGLs is not well studied in Southeast Asia. We reviewed clinical management of PPGLs in Singapore, highlighting current gaps in clinical practice. METHODS: Medical records of patients with PPGLs between 2005 and 2016 were reviewed. Diagnosis was confirmed histologically and stratified into sporadic or familial/syndromic (FS). RESULTS: Twenty-seven (21.8%) patients were referred to the Cancer Genetics Service (CGS). FS PPGLs (18.5%) and extra-adrenal PPGLs (58.1%) incidences were higher than previous studies. Referrals were lower for sporadic PPGLs compared to FS PPGLs (3.7% vs. 100%). Referrals were highest at diagnosis age <20 years old (80%) and decreased with increasing age; ≥20-<40 years old (32.1%), ≥40-<60 years old (10.6%). Genetic testing was taken up in 12/27 (44.4%) patients of which 7/12 (58.3%, 3 SDHB, 2 SDHD, 2 VHL) had germline mutations. CONCLUSION: Opportunities for genetic testing are frequently missed due to low referral rates in patients with apparently sporadic PPGLs, particularly between ages 20-60.
RESUMEN
Restoration of motion is an important component of success in digital replantation. This is achieved only with rigid bony fixation that allows early post-operative mobilisation. In addition, the technique used should be simple and avoid excessive soft tissue stripping. These aims are difficult to achieve in amputations near the base of the proximal phalanx with existing bone fixation techniques. We describe a modification of the perpendicular loop wiring technique, where one wire loop is intra-articular, which satisfies the above criteria, and describe its application and results in two clinical cases.
Asunto(s)
Hilos Ortopédicos , Traumatismos de los Dedos/cirugía , Articulaciones de los Dedos/cirugía , Fijación Interna de Fracturas/métodos , Reimplantación , Adulto , Traumatismos de los Dedos/diagnóstico por imagen , Articulaciones de los Dedos/diagnóstico por imagen , Humanos , Masculino , Radiografía , Recuperación de la FunciónRESUMEN
Percutaneous trigger release is recognized as an effective minimally invasive procedure with a low complication rate. One prerequisite for percutaneous trigger release is a trigger of Quinnell Type II or higher; that is, a digit that is actively triggering. We describe an additional step in percutaneous trigger release, which enables the surgeon to perform the procedure in digits that are not actively triggering at the point of surgery. This step involves the infiltration of normal saline into the tendon substance distal to the A1 pulley in order to induce triggering.
RESUMEN
Dislocations of the ulnar carpometacarpal joint are easily missed because of a low index of suspicion as well as their subtle clinical and radiological features. Often, the presence of a more obvious adjacent injury also draws attention away from the carpometacarpal joint. Two cases of ring finger metacarpal shaft fractures with associated little finger carpometacarpal joint dislocations are presented. In both cases, the metacarpal fractures were diagnosed but the carpometacarpal joint dislocations were initially overlooked. The presence of an apparently isolated ring finger metacarpal fracture due to an indirect force should raise the possibility of an associated carpometacarpal joint injury.
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Huesos del Carpo/lesiones , Fracturas Óseas/diagnóstico , Luxaciones Articulares/diagnóstico , Articulación Metacarpofalángica/lesiones , Metacarpo/lesiones , Adulto , Huesos del Carpo/cirugía , Fracturas Óseas/terapia , Humanos , Luxaciones Articulares/terapia , Masculino , Articulación Metacarpofalángica/cirugía , Metacarpo/cirugíaRESUMEN
This is a report on the 14 PIA flaps done in our centre for traumatic hand defects over both volar and dorsal aspects, as well as thumb reconstruction over a six-year period from 2000 to 2007. We were able to achieve reach to the DIPJ with the use of fascia extension and better flap survival with more perforators captured in the flap.
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Traumatismos de la Mano/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Adulto , Femenino , Mano/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pulgar/lesiones , Pulgar/cirugía , Arteria CubitalRESUMEN
Displaced distal radius fractures in active elderly patients with high functional demand present a clinical dilemma because current evidence is equivocal in the recommendation of treatment. Internal fixation is an increasingly popular option with proposed superior results. Our study aims to evaluate the results among a population of active elderly patients with displaced fractures managed with either cast immobilization or internal fixation with volar locking plate. Seventy-five patients (35 cast immobilization and 40 internal fixation) with mean age of 74 ± 7.5 years with minimum of 12 months follow-up were studied. The radiological and clinical parameters were assessed at three, six, and 12 months. Functional outcomes (DASH, Green-O'Brien) were assessed at 12 months. Patients who underwent surgery regain wrist motion and grip strength earlier, but this was not statistically significant after six months.
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Placas Óseas , Moldes Quirúrgicos , Descompresión Quirúrgica , Fijación Interna de Fracturas , Fracturas del Radio/terapia , Anciano , Anciano de 80 o más Años , Femenino , Fijación Interna de Fracturas/métodos , Fuerza de la Mano , Humanos , Inmovilización , Masculino , Fracturas del Radio/fisiopatología , Fracturas del Radio/cirugía , Singapur , Resultado del TratamientoRESUMEN
The purpose of this study is to highlight a cohort of patients with a comminuted volar shearing type of distal radius fractures (AO B3.3) with the volar ulnar fragment that is prone to re-displace, resulting in volar subluxation of the radiocarpal joint. We report our experience with two such patients with re-displacement of the fragment and joint requiring repeat surgery; one of whom required a third procedure to stabilize that fragment. Three subsequent patients were successfully treated with one surgery when particular attention was paid to stabilize the volar ulnar fragment. This highlights the importance of stabilizing this fragment at the primary procedure.
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Placas Óseas , Fijación Interna de Fracturas/métodos , Fracturas Conminutas/cirugía , Fracturas del Radio/cirugía , Cúbito/cirugía , Adulto , Estudios de Seguimiento , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Rango del Movimiento Articular , Estudios Retrospectivos , Cúbito/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatología , Articulación de la Muñeca/cirugíaRESUMEN
PURPOSE: To review 9 cases of mechanical failure of the volar locking plate for distal radial fractures. METHODS: Records of 374 consecutive patients who underwent volar locking plating for distal radial fractures were reviewed. Mechanical failures of the volar locking plate were defined as plate breakage or bending, screw breakage or loosening, or collapse of articular fragments resulting in intra-articular screw extrusion. RESULTS: Nine mechanical failures occurred between 2 weeks and 3 months in 8 (2.4%) of the patients aged 25 to 82 (median, 74) years with AO fracture types of A3 (n=4), C1 (n=1), C2 (n=1), and C3 (n=3). Mechanical failures included screw pullout (n=5), locking plate bending (n=2), locking screws breakage (n=1), and loosening of locked variable angle screws (n=1). One patient underwent revision of fixation and 2 underwent implant removal. The remainder were treated conservatively. All patients were followed up for a minimum of 12 months; their mean flexion arc was 87 degrees (standard deviation [SD], 17) and the mean rotation arc was 136 degrees (SD, 29 degrees). According to the Green and O'Brien score, their outcomes were good (n=1), fair (n=4), and poor (n=3). CONCLUSION: Although mechanical failure of volar locking plate is uncommon, some are potentially preventable.
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Placas Óseas , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Placa Palmar/cirugía , Fracturas del Radio/cirugía , Radio (Anatomía)/cirugía , Articulación de la Muñeca/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Placa Palmar/diagnóstico por imagen , Radiografía , Radio (Anatomía)/diagnóstico por imagen , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del Tratamiento , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/fisiopatologíaRESUMEN
VY-plasty is a well-known technique to reconstruct fingertip defects. A simplified method combining pinning of flap and healing of donor site by secondary intention is described. These steps preserve the rounded appearance of the fingertip and restore the convexity of the hyponychium. Flap ischemia due to suture-line tension is also averted.
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Amputación Traumática/cirugía , Traumatismos de los Dedos/cirugía , Colgajos Quirúrgicos , Humanos , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/rehabilitaciónRESUMEN
BACKGROUND: Complex elbow injuries with associated nerve, muscle, or joint injury commonly develop post-inury stiffness. In order to preserve function, joint congruency, elbow stability and durable wound coverage must be achieved in a timely manner. METHODS: A retrospective review of patients who underwent orthopaedic fixation followed by free anterolateral thigh (ALT) flap soft tissue coverage was performed. Five patients were identified and included in this study. RESULTS: We present a series of 5 cases managed with this principle. Soft tissue defects ranged in size from 4×9 cm (36 cm(2)) to 15×30 cm (450 cm(2)) and were located either posteriorly (n=4) or anteriorly (n=1). Associated injuries included open fractures (n=3) and motor nerve transection (n=2). Wound coverage was achieved in a mean duration of 18.8 days (range, 11 to 42 day). There were no flap failures and no major complications. The mean postoperative active elbow motion was 102° (range, 45° to 140°). CONCLUSIONS: In our small series we have highlighted the safety and utility of using the free ALT flap in complex elbow injuries. The ALT flap has many advantages which include abundant skin and subcutaneous tissue; vascularised vastus lateralis muscle that was used in our series to obliterate dead space, provide a vascular bed for nerve grafts and combat infection; and, access to fascia lata grafts for reconstruction of the triceps tendon.