Results of primary reparing of hand extensor tendons injuries using surgical treatment.

UNLABELLED: Injuries of hand extensor tendons occur as isolated or combined injury or multiple tendons injuries associated with injuries of other hand structures. Clinical pictures of these injuries depends on the level of occurred injury, and can be expressed in loss of function extension of one or more fingers, wrist and creating contractures. PATIENTS AND METHODS: This is five-year retrospective study of 87 patients operated at Clinic for Plastic and reconstructive surgery, Clinical Centre University of Sarajevo. We studied the efficiency of primary surgical treatment in hand extensor tendons injuries in the prevention of hand dysfunction. RESULTS AND DISCUSSION: The best recovery results after surgical treatment of hand extensor tendons injury were in zones I, zone II and zone III. But, in zone VII recovery was difficult, and the outcome unpredictable. The most commonly injured zone was zone VI, and in zones of thumb usually violated zone was zone T-III. According to Miller's assessment criteria and recovery functions, after 6 weeks, with excellent finding was 41 (47,1%) and good results 21 (24,0%) of patients, while after 6 months, the excellent results were in 60 (68,9%) and good results in 28,7% of patients, due to well-conducted physical rehabilitation. Only two patient had complications at 6 months after surgery due to very complicated associated injuries of soft tissues and bone structures of the hand. CONCLUSION: Results depends in extensivity of injury, anatomic zone, lack of infection, concomitant injuries, skills and operative methods of surgeon.

Outcomes of ulnar nerve grafting.

INTRODUCTION: The ulnar nerve is a mixed motor and sensory nerve, which making nerve repair more difficult and functional recovery less predictable than pure sensory nerves. Recovery of muscle activity and restoration of sensibility are essential for a functional extremity. A nerve graft, if performed in a tensionless manner, has been shown to generally have better results than an end-to-end approximation performed under tension. PATIENTS AND METHODS: In study period from 1993 through 2008, evaluation was performed in 48 patients with adequate follow-up. The mean follow-up period was 3.4 years (range, 24 months to 8.3 years). The average patient age was 32.4 years (range, from 6 to 71 years). There were 37 male patients and 11 female patients. RESULTS: We analyzed the effect of the age of the patient, level of injury, graft lenght and denervation time on motor and sensory recovery. Values of p < 0.05 were considered significant. Results of motor (chi-square = 8.04, p = 0.154) and sensory recovery (chi-square = 7.53, p = 0.184) were not significantly better in patients younger than 25 years compared to the group of patients older than 25 years. The level of the ulnar nerve injury had an impact on the outcome, with better results both sensory (chi-square = 161., p = 0.000) and motor recovery (chi-square = 238., p = 0.000) in patients with distal lesions. The results were significantly better in the group with graft lenght less than 5 cm compared to those longer than 5 cm for both sensory (chi-square = 72.6, p = 0.000) and motor recovery (chi-square = 196., p = 0.000). The functional results were significantly better for both sensory (chi-square 13.4, p = 0.020) and motor recovery (chi-square = 133., p = 0.000) in the group of patients with denervation time shorther than 6 months. CONCLUSION: The graft length, level of injury and denervation time significantly influenced the functional outcome in both motor and sensory recovery. Better results were in the patients in which the autograft length was up to 5 cm, in patients who were operated within six months from the injury and in patients with distal lesions.

Results of surgery treatment of Dupuytren's contracture in 115 patients.

INTRODUCTION: Dupuytren's disease (DD) is a progressive fibroproliferative disorder of the hand causing digital flexion contracture. Treatment goals include removing or releasing the fibrotic cord to allow extension of the affected finger(s) and restoration of hand function. MATERIAL AND METHODS: In study period from 2001 through 2008, evaluation was performed in 115 patients. Limited or extensive fasciectomy was performed in all patients. Tubiana classification sheme to rate severity of DD was used. RESULTS: There were 106 male patients ( mean age 62.6 years) and 9 female patients (mean age 66.3 years). Before the operation, 38% of all patients were at Tubiana stage I, 32% were at stage II, 22% were at stage III and 8% were at stage IV. Of all patients, 43% were diagnosed with Dupuytren's in only one finger, 39% in two fingers and 18% in three fingers. In 23% of patients DD were diagnosed on both hands. Limited fasciectomy was peformed in 90.4% of patients and extensive fasciectomy in 9.6% of patients. The Tubiana stage achived after surgery was lower in 98% of patients. As a final result after surgery, 66% of patients didn't have contracture, stage I was reported in 28% and stage II in 3% of patients. There were no patients with Tubiana stage III or more after surgery. Postoperative complications were noted in 18% of patients. Wound healing problems were present 12% of patients. Haematoma was reported 5% of patients. Of all patients 22% had diabetes mellitus. CONCLUSION: DD is much more common in male than in female patients. Most of the patients are diagnosed at Tubiana stage I and II. Surgical correction has led to an improvement in most patients. Limited fasciectomy is still the gold-standard in DD treatment. Extensive fasciectomy or dermofasciectomy is preformed only in most severe cases.

Elevated serum C-reactive protein concentration in Bosnian patients with probable Alzheimer's disease.

Studies indicate that inflammatory mechanisms may play an important role in the pathogenesis of Alzheimer's disease (AD). C-reactive protein (CRP), marker and mediator of inflammation, has been detected in lesions typical for the affected areas of AD brain. There have been conflicting reports on serum CRP concentration in AD. Scarce data exist on association of CRP and measures of adiposity in AD patients. Thus, we investigated serum CRP concentration in fifteen overweight institutionalized patients with probable AD and fifteen age-matched control subjects. Body mass index (BMI) and waist/hip ratio (WHR) were calculated for each subject included in the study. Age, systolic and diastolic blood pressure, BMI and WHR did not differ significantly between the two groups. Serum CRP concentration was significantly higher in patients with AD compared to controls (p<0.0001). Although not significant, positive correlations between serum levels of CRP and BMI and WHR were found. Obtained results support the notion that low-grade inflammation is present in patients with AD. Absence of significant association between CRP and measures of total and central adiposity in overweight AD patients needs further investigation and explanation.