ABSTRACT
PURPOSE: We analyzed outcomes after management of enchondroma involving short tubular bones of the hand and foot by curettage and grafting using allogenic bone or bone substitutes. MATERIALS AND METHODS: Twenty-two patients (allogenic bone 15 and bone substitutes 7 patients) were recruited. Clinical results were assessed by pain, cosmetic problem, range of motion of joint and the power of grasp. Radiographic outcomes were analyzed by degree of bone defect. RESULTS: Clinically, 19 patients were classified as excellent and 3 patients as good. Three patients with K-wire fixation had pain with local irritation, which was easily controlled by removal of the K-wires. There were no complications including deep infection, delayed or nonunion, refracture. Radiographically, 20 cases were classified as group 1 (bone defect smaller than 3 mm) and the 2 remaining cases were classified as group 2 (bone defect 4-10 mm). CONCLUSION: Curettage and graft using allogenic bone or bone substitute is an effective modality of treatment for enchondroma involving short tubular bones of the hand and foot. When combined with pathologic fracture, early surgical management could shorten duration of immobilization. Surgical management might be considered for the lesion involving the foot when discovered because of high incidence of pathologic fracture.
Subject(s)
Humans , Bone Substitutes , Chondroma , Curettage , Foot , Fractures, Spontaneous , Hand Strength , Hand , Immobilization , Incidence , Joints , Range of Motion, Articular , TransplantsABSTRACT
PURPOSE: To determine the relationship between the length of distal locking screws and diaphyseal screws in volar plate fixation of distal radius fractures. METHODS: A retrospective review was performed of 169 patients who underwent volar locking plate fixation for treatment of distal radius fractures. All patients received 2.4 mm LCP volar extra-articular distal radius plate (DePuySynthes). The length of the diaphyseal screw which was placed in the elongated hole was correlated with the length of a distal locking screw from radial most (D1) to ulnar most (D4). We also evaluated distal screw penetration of the dorsal cortex and plate removal rate. RESULTS: The length of the diaphyseal screw which was placed in the elongated hole strongly correlated with the length of a distal locking screw. Average D1 screw length was 2 mm longer than the diaphyseal screw, and average D2 screw length was 4 mm longer than the diaphyseal screw. D3 and D4 screw were 6 mm longer than the diaphyseal screw. Plate removal was necessary in 13 patients (8%) due to screw irritation. These patients had significantly longer screws than average. Flexor or extensor tendon ruptures did not occur in this cohort. CONCLUSION: The length of the distal locking screws can be estimated with the length of the diaphyseal screw. This information may help surgeons to select the adequate length of distal locking screws during volar plating of distal radius fractures.
Subject(s)
Humans , Radius , Radius Fractures , Retrospective Studies , Rupture , Tendons , Palmar PlateABSTRACT
PURPOSE: Biofeedback is a major treatment method for constipated patients with non-relaxing puborectalis syndrome. However a significant percent of patients still showed poor outcome, and little has been known about the predictors associated with outcome of biofeedback. The aim of this study was to determine the outcome and identify predictors associated with poor outcome of biofeedback therapy for constipated patients with non- relaxing puborectalis syndrome. METHODS: Fifty-two constipated patients with non-relaxing puborectalis syndrome (median age, 47 years) who had more than one biofeedback session after defecography were evaluated by standardized questionnaire, before, immediately after treatment, and at follow-up. Clinical bowel symptoms and anorectal physiological studies were analyzed. Any differences in demographics, clinical symptoms, and parameters of anorectal physiological study were evaluated between success group (patients felt improvement in symptoms at follow-up) and failure group (patients felt no improvement). RESULTS: Follow up (mean follow-up; 17 months) results were evaluated by an independent observer in 45 patients. At post-biofeedback, 42 (81 percents) patients felt improvement in symptoms, including 7 (13 percents) with complete symptom relief. At follow-up, 25 (56 percents) patients felt improvement in symptoms, including 1 (2 percents) with complete symptom relief. There was a significant reduction in difficult defecation (from 81 to 44, 53 percent, from pre-biofeedback to post-biofeedback, and at follow up respectively; P<0.005, P<0.01), sensation of incomplete defecation (from 90 to 50, 40 percent; P< 0.00001, P<0.000005), laxative use (from 25 to 10, 11 percent; P<0.05), and enema use (from 13 to 0, 2 percent; P<0.01, P<0.05). Normal spontaneous bowel movement was increased from 42 percent pre-biofeedback to 81 percent post-biofeedback (P<0.0001), 80 percent at follow up (P<0.0005). Pre-biofeedback presence of symptoms of bowel habit change predict poor outcome (15 vs. 0 percent; failure vs. success, P<0.05). High pressure zone in prebiofeedback manometry was longer in failure group than in success group (2.80 vs 2.01 cm, P<0.05). In the success group, 11 (44 percent) had a rectocele, 1 (4 percent) had a rectal intussussception, 18 (72 percent) had a descending perineal syndrome, and 3 (12 percent) had a sigmoidocele. In the failure group, 4 (20 percent) had a rectocele, and 1 (5 percent) had a rectal intussusception, 14 (70 percent) had a descending perineal syndrome, and a sigmoidocele was not accompanied (P<0.05). Accompanied rectocele, rectal intussusception, descending perineal syndrome, and sigmoidocele did not influence outcome. CONCLUSIONS: Biofeedback is an effective option and should be considered as the first line therapy. Bowel habit change and long high pressure zone in pre-biofeedback manometry were predictors associated with poor outcome of biofeedback therapy for constipated patients with non-relaxing puborectalis syndrome.
Subject(s)
Humans , Biofeedback, Psychology , Defecation , Defecography , Demography , Enema , Follow-Up Studies , Intussusception , Manometry , Surveys and Questionnaires , Rectocele , SensationABSTRACT
PURPOSE: To assess the effectiveness of cinedefecography (CD), anal electromyography (EMG), and anal manometry (ARM) for the diagnosis of non-relaxing puborectalis syndrome (NRPR) and to compare the outcomes for patients after biofeedback therapy (BF). METHODS: The clinical criteria used in this study for NRPR included straining, incomplete evacuation, tenesmus, and the need for enemas, suppositories, or digitation. Patients who satisfied the clinical criteria were evaluated by use of anorectal physiology tests: CD, EMG, and ARM. The EMG criteria included failure to achieve a significant decrease in the electrical activity of the puborectalis (PR) during attempted evacuation. The ARM criteria included failure to achieve a significant decrease in intra-anal pressure during attempted evacuation. The CD criteria included either paradoxical contraction or failure of the PR to relax together with incomplete evacuation. Other possible etiologies for incomplete evacuation, such as rectal intussusception or rectocele, were excluded in all cases. Fifty-eight constipated patients diagnosed as having NRPR by at least one of anorectal physiolosic tests had more than one BF session. The outcomes for fifty-one patients (mean age, 44.8 years; male-to-female ratio, 22:29) were reported as either improved or unimproved at a mean follow-up of 12.7 (range, 2~30) months. The sensitivities, the specificities, and the positive and negative predictive values for the CD, EMG, and ARM diagnoses of NRPR were calculated to assess the diagnostic accuracy of each test and to identify predictors associated with the outcome of BF. RESULTS: The sensitivities of EMG, CD, and ARM were 96%, 89%, and 85%, respectively (P>0.05). The positive predictive values of the three tests were 63% for EMG, 52% for ARM, and 51% for CD (P>0.05). The negative predictive values of the three tests were 90% for EMG, 43% for ARM, and 25% for CD (P0.05). CONCLUSIONS: A combination of the CD and the EMG tests is suggested for the diagnosis of NRPR.