ABSTRACT
INTRODUCTION: Palmar plate fixation of unstable distal radial fractures is quickly becoming the standard treatment for this common injury. The literature reporting complications consists mainly of isolated case reports or small case series. METHOD: Between February 2004 and December 2009 palmar plate fixation was performed in 665 cases. The overall complication rate was 11.3 % (75 complications). Revision surgery was necessary in 10 % (65 procedures). RESULTS: The reasons for revision surgery were: postoperative median nerve compression (22 patients) and secondary dislocation (9 patients). An ulna shortening osteotomy for ulnar impingement syndrome was necessary in eight cases. Intraarticular screw placement occurred in three patients. There were two flexor pollicis longus, one finger flexor and three extensor pollicis longus tendon ruptures. Posttraumatic compartment syndrome of the forearm requiring fasciotomy occurred in four cases. There were three cases of infection. Nonoperative treatment was necessary in nine patients, who developed a complex regional pain syndrome. Hardware failure occurred in three cases. Hardware removal was performed in 232 (34 %) cases. CONCLUSION: Palmar plate fixation of distal radius fractures is a safe and effective procedure. Nevertheless, complications necessitating a second intervention are relatively common. A proportion of these complications is iatrogenic and can be avoided by improving the surgical technique.
Subject(s)
Bone Plates , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/instrumentation , Radius Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Fracture Fixation, Internal/methods , Humans , Male , Middle Aged , Palmar Plate , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Young AdultABSTRACT
OBJECTIVE: The aim of this study was to investigate prenatal and postnatal growth of twins with twin-twin transfusion syndrome (TTTS) after intrauterine laser coagulation. STUDY DESIGN: The weight and length of 54 sets of twins with severe TTTS surviving intrauterine laser coagulation at the intervention (median 20+4 weeks), at birth (median 34+3 weeks) and on the occasion of neurodevelopmental follow-up (median age 3 years 10 months) were investigated. All data were converted to Z scores, and groups were compared by two-tailed paired t test. RESULTS: At all time points, donors are significantly lighter than recipients (p<0.001). After laser treatment the weight Z score of donors until birth remains unchanged (p=0.76), whereas recipients lose weight significantly (p<0.01). Postnatally, both donors and recipients show catch-up growth. CONCLUSION: Intrauterine laser coagulation stops growth acceleration in recipients that leads to a decrease in intertwin discordance. After birth, significant catch-up growth was observed for the donor group (p<0.001).
Subject(s)
Fetal Development/physiology , Fetofetal Transfusion/surgery , Growth/physiology , Laser Coagulation , Body Height , Body Weight , Child Development/physiology , Child, Preschool , Female , Fetal Weight , Fetofetal Transfusion/physiopathology , Humans , Pregnancy , Twins, MonozygoticABSTRACT
Twin-twin transfusion syndrome (TTTS) is caused by unbalanced shunting of blood between monochorionic twins. It is well known that chronic hypotension and hypovolemia may cause renal insufficiency in the donor twin. The long-term outcome of kidney function after TTTS has not previously been delineated in the literature, however. The aim of this study was to evaluate the long-term outcome of kidney function in children after intrauterine laser treatment for severe TTTS. Eighteen surviving twin pairs after intrauterine laser treatment for TTTS were involved in the study. Their gestational age at birth was 29-39 weeks, their median birth weight was 2050 g, and their median age at evaluation was 3 years 1 month, range 1 year 9 months to 4 years 5 months. Serum creatinine, cystatin C, and beta 2-microglobulin, sodium, potassium, and phosphate excretion, and urine albumin and alpha-1-microglobulin were measured. Creatinine clearance was calculated by use of the Schwartz formula. The laboratory findings for all 36 children were within normal limits. There were no significant differences between donors and recipients. Despite severe alteration of renal function before the laser treatment (anuria-polyuria) no long-term impairment of renal function could be detected in any of the 18 twin pairs.
