ABSTRACT
INTRODUCTION: The purpose of this paper is to share the outcome of cases of scaphoid non-union treated with 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) vascularised graft at our institution, as well as to identify the possible factors for the failure of the procedure. METHODS: This was a retrospective review of 13 cases of scaphoid fracture non-union treated with 1,2 ICSRA vascularised bone grafting from October 2000 to March 2003. A clinical and radiological review was conducted. Linear regression was performed in order to identify the factors associated with a negative outcome. RESULTS: Out of the 13 patients with scaphoid non-union, ten (77 percent) had avascular necrosis of the proximal pole. The patients were followed up for a mean duration of 13 (range 3-28) months. Ten out of the 13 (77 percent) patients achieved union. CONCLUSION: Our results are comparable to those reported by other studies and indicate that avascular necrosis was associated with failure to achieve union.
Subject(s)
Arteries/pathology , Bone Transplantation/methods , Fractures, Ununited/surgery , Scaphoid Bone/blood supply , Adult , Fractures, Bone/surgery , Humans , Male , Necrosis/pathology , Orthopedics/methods , Radiography , Regression Analysis , Retrospective Studies , Scaphoid Bone/diagnostic imaging , Time Factors , Treatment OutcomeABSTRACT
Isolated trapezoid fractures are rare. We present a case of severe isolated trapezoid fracture associated with bone loss and proximal migration of the second metacarpal, which was treated successfully by open reduction and internal fixation with bone grafting and joint fusion.
Subject(s)
Arthrodesis/methods , Fractures, Bone/diagnostic imaging , Trapezoid Bone/injuries , Wrist Injuries/complications , Accidents, Traffic , Adult , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Male , Tomography, X-Ray Computed , Trapezoid Bone/diagnostic imaging , Trapezoid Bone/surgery , Trauma Severity Indices , Wrist Injuries/diagnostic imaging , Wrist Injuries/surgeryABSTRACT
Trigger digit release is a common surgical procedure with a low complication rate. One of the potential complications is digital nerve injury. Though uncommon, digital nerve injury can be significantly symptomatic to the patient. We report a case of radial digital nerve neuroma formation following trigger release of the middle finger, which is considered to be safe, in terms of risk of digital nerve injury. We discuss our management of the complication, possible pitfalls which may have resulted in the complication in our case and offer possible means of overcoming these pitfalls.
Subject(s)
Fingers/innervation , Neoplasms, Post-Traumatic/etiology , Neuroma/etiology , Orthopedic Procedures/adverse effects , Peripheral Nervous System Neoplasms/etiology , Radial Nerve/injuries , Trigger Finger Disorder/surgery , Diagnosis, Differential , Female , Fingers/surgery , Humans , Metacarpophalangeal Joint/innervation , Metacarpophalangeal Joint/surgery , Middle Aged , Neoplasms, Post-Traumatic/diagnosis , Neoplasms, Post-Traumatic/surgery , Neuroma/diagnosis , Neuroma/surgery , Neurosurgical Procedures/methods , Peripheral Nervous System Neoplasms/diagnosis , Peripheral Nervous System Neoplasms/surgery , Radial Nerve/surgeryABSTRACT
Malunions of forearm fractures in adults can present with limitation of forearm rotation, or as distal radioulnar joint instability with functional impairment. This contrasts with paediatric patients in whom malunions of similar severities are often better tolerated. We did a retrospective review of six adult patients after corrective forearm osteotomy for symptomatic malunited forearm shaft fractures. The corrective operations were done between 7 and 168 months after initial injury, using oblique or wedge osteotomies. Median follow-up was 22.5 months. The patients recovered well, with statistically significant improvement in forearm rotation and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. No significant complications occurred.
Subject(s)
Fractures, Malunited/surgery , Osteotomy/methods , Radius Fractures/surgery , Radius/surgery , Ulna Fractures/surgery , Adolescent , Adult , Elbow Joint/physiopathology , Female , Fractures, Malunited/physiopathology , Humans , Male , Middle Aged , Range of Motion, Articular , Ulna/surgery , Wrist Joint/physiopathology , Young AdultSubject(s)
Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/surgery , Vibrio Infections/surgery , Vibrio vulnificus , Adult , Amputation, Surgical , Ankle Injuries/complications , Debridement , Fatal Outcome , Female , Foot Injuries/complications , Humans , Male , Middle Aged , Sprains and Strains/complicationsABSTRACT
High pressure injection injuries are well known to cause significant injury to the hand, with high amputation rates and poor functional outcome. Surgical treatment consists of early aggressive debridement followed by secondary closure. Flap reconstruction is a reconstruction option which can increase the chance of digit salvage, as well as give an acceptable functional and cosmetic result. We review three cases of flap reconstruction following high pressure injection injuries, and discuss their role in the treatment of these injuries.
Subject(s)
Finger Injuries/surgery , Foreign Bodies/surgery , Surgical Flaps , Wounds, Penetrating/surgery , Adult , Cellulitis/pathology , Cellulitis/surgery , Debridement , Finger Injuries/pathology , Foreign Bodies/pathology , Hand Strength , Humans , Male , Middle Aged , Necrosis , Paint , Pressure/adverse effects , Range of Motion, Articular , Treatment Outcome , Wounds, Penetrating/pathologyABSTRACT
We have studied the effects of sustained local anaesthesia on postoperative mobilization of the injured hand. Small epidural catheters were placed adjacent to the peripheral nerves providing sensation to the involved part of the hand under direct vision in the distal forearm. Repeated doses of 0.5% bupivacaine were then administered during mobilization therapy to relieve pain. Fourteen out of 24 digits (60%) recorded 30 degrees or more increases in active range of motion after bupivacaine injection. The cases that failed to improve had suffered severe injuries. Complications were few and were easily managed as the catheters were distal, superficial and accessible. This is an effective, specific and safe method of providing sustained postoperative analgesia for mobilization.
Subject(s)
Anesthesia, Local/instrumentation , Anesthetics, Local , Bupivacaine , Catheters, Indwelling , Finger Injuries/surgery , Pain, Postoperative/prevention & control , Physical Therapy Modalities , Postoperative Complications/rehabilitation , Adolescent , Adult , Early Ambulation/instrumentation , Equipment Design , Female , Humans , Male , Middle Aged , Motor Skills/drug effects , Pain Measurement , Prospective Studies , Range of Motion, Articular/drug effectsABSTRACT
INTRODUCTION: Sauve-Kapandji procedure is used to treat distal radioulnar joint disorder. MATERIALS AND METHOD: Sixteen patients with distal radioulnar joint (DRUJ) disease treated with Sauve-Kapandji procedure between 1996 and 1998 were available for review at an average follow up period of 32.8 months,ranging from 24 to 48 months. The patients were young and the average age at the time of procedure was 33.6 years. There were eight cases of post-traumatic DRUJ arthritis, two cases of dislocation of DRUJ with malunion of radial fractures and six cases of rheumatoid patients with destruction of DRUJ. The distal end of ulnar shaft was stabilised with a sling created using radial 1/2 slip of extensor carpi ulnaris (ECU) tendon. Functional results were evaluated with Mayo wrist score. RESULTS: Fusion of DRUJ was achieved in all cases by two months. Excellent results were achieved in eight cases, good in six, fair in one and poor in one. All except one case gained increase range of forearm rotation. Complications included one case of closure of pseudoarthrosis and required excision of the ulna head to restore forearm rotation. CONCLUSION: Sauve-Kapandji procedure is recommended in young patients with distal radioulnar joint disorder.