RESUMO
A drug-addicted patient injected himself intra-arterially with a mixture of methadone, flunitrazepam, saliva and water. The resulting compartment syndrome could be treated by fasciotomy and multiple debridement, with which a major amputation could be prevented. The course of the treatment and the resulting functional results are described, as well as a brief overview of the literature and a treatment proposal for similar cases.
Assuntos
Síndromes Compartimentais , Flunitrazepam , Antebraço , Metadona , Saliva , Adulto , Síndromes Compartimentais/induzido quimicamente , Síndromes Compartimentais/cirurgia , Desbridamento , Usuários de Drogas , Fasciotomia , Antebraço/patologia , Antebraço/cirurgia , Humanos , Injeções Intra-Arteriais , Masculino , Resultado do Tratamento , Água/químicaRESUMO
PURPOSE: For nonsurgical treatment of fractures of the proximal phalanges of the triphalangeal fingers, different dynamic casts have been described. The main principle behind these casts is advancement and tightening of the extensor hood, caused by a combination of blocking the metacarpophalangeal joints in flexion and actively flexing the proximal interphalangeal joints. In contrast to established treatment protocols using functional forearm casts, the Lucerne cast allows for free mobilization of the wrist joint. The purpose of the current multicenter study was to compare the results of conservative, functional treatment using 2 different methods, either a forearm cast or a Lucerne cast. METHODS: Over a 2-year-period, a prospective, randomized, multicenter study was conducted at 4 hospitals in Switzerland. Clinical and radiological results of 66 consecutive patients having 75 extra-articular fractures of the proximal phalanges were recorded through a minimum follow-up of 3 months. Intra-articular and physeal fractures, pathological fractures, open fractures, concomitant injuries of the tendons or collateral ligaments, and accidents more than 7 days before presentation were excluded from the study. RESULTS: Radiographically, there were no statistically significant differences between the 2 groups in terms of palmar apex angulation and radial or ulnar angulation. There were no differences in total active range of finger motion. Wrist joint motion at the time of cast removal was statistically superior in patients treated with Lucerne cast. However, there were no significant differences in wrist joint motion at 12 weeks of follow-up. CONCLUSIONS: The clinical and radiological results achieved with the Lucerne cast are comparable to those of established treatment. Well-reduced, minimally angulated, or nonangulated fractures of the proximal phalanges of the fingers can be effectively treated using functional casts without immobilizing the wrist. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.
Assuntos
Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Braquetes , Moldes Cirúrgicos , Feminino , Falanges dos Dedos da Mão/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Suíça , Resultado do TratamentoRESUMO
BACKGROUND: Literature provides little and controversial evidence regarding the influence of ulnar variance (UV) on the incidence of scaphoid fractures. The aim of this retrospective study was to assess UV in a large number of patients with acute scaphoid fracture in comparison to a control group of the same population. METHODS: During a two year period, 182 patients with acute scaphoid fractures (fracture group) and 182 ethnicity-, gender- and age-matched patients with wrist contusions (control group) were treated in three non-university hospitals. Using standardized digital wrist radiographs, UV values were measured by means of the method of perpendiculars by two independent examiners. The UV values of the fracture group were then compared to the UV values of the control group. RESULTS: Analyses of the agreement between the two raters resulted in a good to excellent inter-item correlation of 0.89, with a high intra-class coefficient of 0.93 (95% confidence interval: 0.87-0.95). Mean (SD) UV value was -0.82 mm (1.77) in the fracture group and 0.27 mm (1.44) in the control group. Paired sample t-test showed a significant difference between the two groups (p < 0.0001). CONCLUSIONS: According to this study, patients with scaphoid fractures are significantly more likely to show a negative UV than matched patients with wrist contusions.
Assuntos
Fixação de Fratura/métodos , Fraturas Ósseas/cirurgia , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adulto , Feminino , Fraturas Ósseas/diagnóstico , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Traumatismos do Punho/diagnósticoRESUMO
A professional cellist suffered four years from pain and fatigue of unknown etiology to his right thumb while playing his cello. These complaints in his performing right hand were potentially threatening his future career, since he was no longer able to play his instrument. Finally, the diagnosis of an anomaly of the insertion of the palmaris longus tendon was made. After resection of the distal portion of this tendon, the patient's symptoms fully resolved. Anatomic anomalies of the upper limb and particularly of the palmaris longus muscle-tendon unit are frequent and may lead to serious complaints in certain professional groups.
Assuntos
Músculo Esquelético/anormalidades , Música , Doenças Profissionais/cirurgia , Dor/etiologia , Tendões/anormalidades , Polegar/cirurgia , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Músculo Esquelético/cirurgia , Doenças Profissionais/diagnóstico , Tendões/cirurgiaRESUMO
Desmoid tumor of the breast is a rare lesion. So far only 8 cases in which the tumor origin was linked to a breast implant have been published. Whether there is an etiological relation to the silicone implant or if it is pure coincidence is not evident at this time. We present the case of a 24-year-old female with congenital asymmetric breasts who underwent breast augmentation in our division on the left side and 15 months later had a breast reduction on the other side. Nine years after the first operation we found a suspicious lesion on the side of the breast implant. The histological result of the excisional biopsy showed an aggressive fibromatosis "arising from" the capsule around the silicon implant. We discuss the possible association of breast implant and desmoid tumor of the breast and evaluate the diagnostic and therapeutic options for desmoid tumors of the breast.
Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/etiologia , Fibromatose Agressiva/etiologia , Silicones , Adulto , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Fibromatose Agressiva/radioterapia , Fibromatose Agressiva/cirurgia , Seguimentos , Humanos , Tomografia por Emissão de Pósitrons , Dosagem Radioterapêutica , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
We report a case of a 62 year old woman who presented with Ogilvie's syndrome as a complication of mastectomy with free TRAM flap reconstruction due to angiosarcoma of the right breast. In the acute postoperative period, the patient expired as a result of Ogilvie's syndrome related complications. Several assumptions regarding the causes of Ogilvie's Syndrome as well as current theories about aetiology, diagnosis and therapy are discussed in this case presentation.
Assuntos
Neoplasias da Mama/cirurgia , Pseudo-Obstrução do Colo/etiologia , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/cirurgia , Hemangiossarcoma/cirurgia , Mamoplastia/efeitos adversos , Mastectomia Radical/efeitos adversos , Retalho Miocutâneo/efeitos adversos , Retalho Miocutâneo/cirurgia , Complicações Pós-Operatórias/etiologia , Ceco/irrigação sanguínea , Ceco/patologia , Colo/irrigação sanguínea , Colo/patologia , Pseudo-Obstrução do Colo/diagnóstico , Pseudo-Obstrução do Colo/terapia , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Isquemia/diagnóstico , Isquemia/etiologia , Isquemia/terapia , Excisão de Linfonodo , Futilidade Médica , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , ReoperaçãoRESUMO
BACKGROUND: The aim of this study was to investigate retrospectively if soft tissue injuries have an impact on the functional results of surgically treated intra-articular fractures of the base of the middle phalanx. PATIENTS AND METHODS: From 1/2007 to 4/2010 we operated on 27 patients with intra-articular fractures of the base of the middle phalanx with pins, screws or external fixation analogous to Suzuki. 5 patients were excluded. 13 patients had no significant soft tissue injury (kWTV group), 9 patients had significant soft tissue damage including open fractures, skin lesions or/and severe soft tissue swelling (WTV group). Postoperative function and complications were analysed based on total active range of motion (TAM) and range of motion of the proximal interphalangeal joint (PIP-ROM) with regard to the Larsen score and clinical data. RESULTS: Fractures with soft tissue injuries had a significantly worse TAM outcome (p=0.04) than fractures without soft tissue injury (kWTV group: TAM 197.1°; WTV group TAM 231.2°) even if the functional results regarding the Larsen classification were excellent or good in both groups (kWTV 100%, WTV 88.9%). There were no significant differences regarding PIP-ROM of both groups. CONCLUSION: Soft tissue injuries have a negative impact on the functional results of surgical treated intra-articular fractures of the base of the middle phalanx. The influence on PIP-ROM might be less. Other factors might play a considerable role for PIP-ROM. With an adequate operative treatment most intra-articular middle phalanx fractures show good to excellent functional -results.
Assuntos
Fixadores Externos , Traumatismos dos Dedos/cirurgia , Articulações dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Expostas/cirurgia , Fraturas Intra-Articulares/cirurgia , Complicações Pós-Operatórias/etiologia , Lesões dos Tecidos Moles/cirurgia , Adulto , Idoso , Pinos Ortopédicos , Parafusos Ósseos , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Traumatismos dos Dedos/fisiopatologia , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/fisiopatologia , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/fisiopatologia , Fraturas Expostas/diagnóstico por imagem , Fraturas Expostas/fisiopatologia , Força da Mão/fisiologia , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Radiografia , Amplitude de Movimento Articular/fisiologia , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/fisiopatologia , Adulto JovemRESUMO
Sepsis is the third most common cause of death in Germany. Every fourth patient with sepsis has urosepsis. Even if substantial therapeutic progress has been made, sepsis remains a severe condition with high morbidity and mortality that requires rapid interdisciplinary measures. Besides life-threatening complications, acral necrosis as presented here can occur as a result of disseminated intravascular coagulation and severe microcirculatory disorders.
Assuntos
Bacteriemia/complicações , Doenças do Tecido Conjuntivo/microbiologia , Tecido Conjuntivo/patologia , Infecções por Escherichia coli/complicações , Nefrolitíase/complicações , Pele/patologia , Idoso , Bacteriemia/diagnóstico , Bacteriemia/terapia , Doenças do Tecido Conjuntivo/diagnóstico , Doenças do Tecido Conjuntivo/terapia , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/terapia , Dedos/patologia , Humanos , Masculino , Necrose/etiologia , Necrose/patologia , Necrose/terapia , Nefrolitíase/diagnóstico , Nefrolitíase/terapia , Dedos do Pé/patologia , Resultado do TratamentoRESUMO
The aim of the study was to retrospectively present and analyse the functional results of surgically treated extraarticular fractures of the proximal phalanx.From 1/2005-4/2008 we operated on 49 patients with 52 closed, extraarticular fractures of the proximal phalanx of the long fingers with either pins, screws or plates. 30 patients were male, 19 were female, the mean age was 35 years. Open fractures, fractures of the thumb and those with injuries to neurovascular structures or tendons were excluded. Postoperative physiotherapy was started on day 1 after surgery. Postoperative finger function and complications were analysed based on the total active motion (TAM) regarding the Belsky score and the classification of Page and Stern. In addition, patients were contacted by phone in 4/2009 to verify the subjective functional results at the end of the observation period.Three different operative procedures were employed: internal fixation by Kirschner wires (n=25), and open fixation by screws (n=8) or plates (n=19). The entire treatment period amounted to 12 (4-28) weeks, the observation time was 33 (11-50) months. Two patients, both after plate osteosynthesis, had to be reoperated because of functional deficits due to adhesions. In both a tenolysis and removal of the plate was performed. The functional result was excellent in 20 of 25 patients treated by Kirschner wires, in seven of the eight in the screw-fixation group and in 13 of the 19 patients treated by plate ostheosynthesis (TAM > 240°); the result was judged fair in 1 after plate osteosynthesis (TAM 215°). The remaining 11 patients showed a good outcome with a TAM between 220° and 239°. These favourable results remained subjectively stable at the end of the observation period, when all patients could be contacted by phone.Osteosynthesis by kirschner wires, screws and plates for closed extraarticular fractures of the proximal phalanx of the long fingers gives good to excellent results with few complications.
Assuntos
Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Traumatismos dos Dedos/cirurgia , Falanges dos Dedos da Mão/lesões , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas/métodos , Adolescente , Adulto , Idoso , Criança , Feminino , Traumatismos dos Dedos/diagnóstico por imagem , Falanges dos Dedos da Mão/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Radiografia , Amplitude de Movimento Articular/fisiologia , Reoperação , Estudos Retrospectivos , Aderências Teciduais/cirurgia , Adulto JovemRESUMO
We report on the very rare occurrence of a multicentric localised giant cell tumour of the tendon sheath on both hands with a focal infiltration of the extensor tendon tissue in a 39-year-old otherwise healthy man.