RESUMO
Wrist pain is a common presentation to the general practitioner and emergency department. Most cases are simple to treat, and pain frequently resolves with conservative treatment. However, there are certain conditions, such as scaphoid nonunion and Kienböck's disease, where delayed diagnosis and treatment can result in long-term deformity or disability. This article covers the various causes of wrist pain, recommendations on how wrist pain should be assessed, as well as details some of the common conditions that warrant specialist referral.
Assuntos
Humanos , Dor Aguda , Diagnóstico , Reabilitação , Artralgia , Diagnóstico , Reabilitação , Dor Crônica , Diagnóstico , Reabilitação , Avaliação da Deficiência , Fraturas não Consolidadas , Diagnóstico , Procedimentos Ortopédicos , Métodos , Osteonecrose , Diagnóstico , Medição da Dor , Osso Escafoide , Ferimentos e Lesões , Traumatismos do Punho , Diagnóstico , Reabilitação , Articulação do PunhoRESUMO
<p><b>INTRODUCTION</b>Early debridement and coverage has long been regarded as the standard of care for open fractures of the lower limb, as infection is a serious complication. However, the best time for wound closure remains controversial. Negative-pressure wound therapy (NPWT) is thought to result in reduced flap infection and failure. To determine the effect of NPWT, we reviewed patients with open fractures of the lower limb and compared the rates of infection and flap failure in two time-based cohorts.</p><p><b>METHODS</b>Two cohorts of patients (periods 2003-2004 and 2008-2009) with Gustilo type IIIB open tibial fractures were recruited and their outcomes were compared. In the 2003-2004 cohort, wounds were dressed with occlusive dressing. In the 2008-2009 cohort, all patients underwent NPWT. Data was retrospectively analysed with regard to infection, failure, age, type of flap, comorbidities and defect size. The incidences of infection and flap failure were further analysed for any statistical difference between the different treatment protocols.</p><p><b>RESULTS</b>In the 2003-2004 cohort, 33% of patients developed infection and 11% had flap failure. However, in the 2008-2009 cohort, 10% of patients developed infection and 6% had flap failure. The difference in the incidence of infection was statistically significant between the two cohorts (p = 0.029).</p><p><b>CONCLUSION</b>Patients in the 2008-2009 cohort had better outcomes, and we are of the opinion that performing NPWT may have contributed to this result.</p>
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Estudos de Coortes , Desbridamento , Métodos , Seguimentos , Fixação Interna de Fraturas , Métodos , Fraturas Expostas , Diagnóstico , Cirurgia Geral , Rejeição de Enxerto , Escala de Gravidade do Ferimento , Traumatismos da Perna , Diagnóstico , Cirurgia Geral , Tratamento de Ferimentos com Pressão Negativa , Radiografia , Estudos Retrospectivos , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica , Diagnóstico , Cirurgia Geral , Fraturas da Tíbia , Diagnóstico por Imagem , Cirurgia Geral , Resultado do Tratamento , Cicatrização , FisiologiaRESUMO
<p><b>INTRODUCTION</b>Hand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments. This study aimed to determine the knowledge of hand surgery and hand surgical conditions among general practitioners.</p><p><b>METHODS</b>A questionnaire survey was conducted during a continuing medical education symposium on hand surgery in Singapore. Participants responded to 12 questions on hand trauma by keying the answers into a computer database system. The results were then analysed.</p><p><b>RESULTS</b>A total of 35 general practitioners responded to our survey, and they were able to answer 53% of the questions correctly. We found knowledge gaps among the participants regarding hand surgical conditions, and identified areas where increased education during medical school, postgraduate training and continuing medical education may be beneficial. Areas that were found to be weak included recognising injuries that pose a high risk for developing wound infection, complications of topical steroid injection in trigger finger treatment and hand tumours.</p><p><b>CONCLUSION</b>Improving hand surgery knowledge among general practitioners not only leads to improved primary care, but it can also facilitate prompt recognition of surgical problems and subsequent referral to appropriate hand surgeons for treatment. This may possibly reduce the load of tertiary institutions in treating non-urgent hand conditions.</p>