ABSTRACT
Background: The development of trigger digit after carpal tunnel syndrome release surgery has been widely reported. Lluch described reconstruction of the flexor retinaculum in elongated position to prevent such complication. Methods: We conducted a retrospective review to determine whether patients who undergo reconstruction in elongated position of the flexor retinaculum have a lower incidence of trigger digit postoperatively. In total, 1050 patients were included, 865 of whom had undergone traditional carpal tunnel release and 185 flexor retinaculum reconstruction. Results: No differences were found in the incidence of trigger digit after surgery (8.7% of the patients who underwent traditional release vs 11.9% in the reconstruction group). Neither difference was found when comparing mean time with the development of trigger digit. Conclusions: In the absence of randomized long-term studies comparing traditional release and reconstruction in elongated position after carpal tunnel release, given our results, we see no reason to favor reconstruction over standard carpal tunnel release as a means to prevent postoperative triggering of digits.
Subject(s)
Carpal Tunnel Syndrome , Trigger Finger Disorder , Carpal Tunnel Syndrome/surgery , Humans , Incidence , Retrospective Studies , Trigger Finger Disorder/epidemiology , Trigger Finger Disorder/surgeryABSTRACT
BACKGROUND: Trochanteric fractures are one of the most common fractures in elderly people. The use of intramedullary nails is an option for their treatment, especially in unstable patterns. Nail breakage is a rarely reported complication. The aim of this study was to determine the prevalence of nail breakage in our center. Secondary objectives are to show the management of this complication in our institution as well as the technical problems, complications and final outcomes of these patients in our hands. MATERIAL AND METHODS: In a retrospective case series review between 2010 and 2015, we analyzed 1481 patients with trochanteric and subtrochanteric fractures who had been treated by cephalomedullary nailing in our centre. 13 patients with nail breakage were identified. RESULTS: The percentage failure rate in our institution is 0.87%. 9 (69.2%) patients were women and 4 (3.8%) were men, with a mean age of 74.6 years (range 47-90). In all cases the mechanism of injury was a simple fall from standing height. Initial fracture types were: 1 case of AO/OTA 31A1, 6 cases of AO/OTA 31A2 and 6 cases of AO/OTA 31A3. Only 3 cases had a good overall reduction with a correct TAD, an optimal femoral neck-shaft angle and absence of fracture gaps >5 mm after surgery. The average time from the first surgery to the diagnosis of implant breakage was 333 days (range 70-1460), 11 months. Breakage occurred at the nail junction with the lag screw in 11 cases and in the distal nail aperture in 2 cases. CONCLUSIONS: An insufficient reduction with varus and fracture gaps >5 mm, the use of short nails in unstable patterns with subtrochanteric involvement and patients with certain comorbidities are facts observed that can contribute to the development of delayed or nonunion with subsequent nail breakage. Different salvage treatments, conversion to hip arthroplasty or revision osteosynthesis, may be considered but we think that prevention has to be the best treatment.
Subject(s)
Bone Nails , Equipment Failure , Fracture Fixation, Intramedullary/adverse effects , Hip Fractures/surgery , Salvage Therapy/statistics & numerical data , Aged , Aged, 80 and over , Bone Nails/adverse effects , Female , Hip Fractures/epidemiology , Humans , Male , Middle Aged , Prevalence , Retrospective Studies , Spain/epidemiology , Treatment OutcomeABSTRACT
La Debilidad muscular aguda (DMA) constituye la pérdida de fuerza muscular más o menos generalizada que se instaura en el transcurso de pocas horas o días y siempre antes de cuatro semanas. Este síndrome puede ser debido a una larga lista de enfermedades y se presenta con relativa frecuencia, especialmente en las áreas de urgencias, pudiendo llegar a constituir una emergencia médica. El objetivo de este estudio fue determinar la incidencia y las características clínicas y epidemiológicas de los pacientes con diagnóstico de debilidad muscular aguda, que hayan sido atendidos en el servicio de emergencias del Instituto Nacional del Niño, entre enero y diciembre del año 2008. Se realizó un estudio de carácter descriptivo y retrospectivo, consistente en la revisión de historias clínicas de pacientes con diagnóstico de Debilidad Muscular Aguda hospitalizados en el INSN durante el mes de Enero hasta Diciembre del año 2008. Se utilizaron criterios de inclusión (edad hasta 17 años, debilidad muscular progresiva) y exclusión (Astenia, síndromes atáxicos, impotencia funcional y hemiplejia) aguda para la de datos en la ficha diseñada para tal fin. Se realizó un cruce de variables en tablas de doble entrada. El análisis descriptivo se realizó en medidas de tendencia central, de posición y de variabilidad. De un total de 27 pacientes con diagnóstico de DMA, el 47 por ciento tuvo como diagnóstico polirradiculoneuropatía inflamatoria desmielinizante aguda o Síndrome de Guillain Barré(predominando en varones), el síndrome de debilidad muscular fue la segunda enfermedad más frecuente con 14 por ciento y con 11 por ciento otras polineuropatías. La moda calculada en este estudio fue 8 y la mediana resultó de 6,5...
The acute muscular weakness constitutes the loss of muscle strength that is established in the course of a few hours or days and always within four weeks. This syndrome can be due to a several kinds of diseases and appears with relative frequency, especially in urgencies, being able to constitute a medical emergency. The aim of this study was to determine the incidence and clinical and epidemiological characteristics of patients with acute muscle weakness, which have been treated in the emergency department of the National ChildrenÆs Institute, from January to December 2008. There was realized a study of character descriptive and retrospective, consisting of the review of patient's clinical histories by diagnosis of Acute Muscular Weakness hospitalized in the INSN during January until December 2008. There were in use criteria of incorporation (age up to 17 years, muscular progressive weakness) and exclusion (Debility, ataxic syndromes, functional impotence and acute hemiplegic) for that of information in the card designed for such purpose. A crossing variable was realized in tables of double entry, The descriptive analysis was realized in measures of central trend; of position and of variability. 27 patients of al/, with diagnosis of DMA, 47 per cent was diagnose with Guillain Barré's Syndrome as a diagnosis polirradiculoneuropathy (prevailing in males), the syndrome of muscular weakness was the most frequent second disease with 14 per cent an with 11 per cent other polineuropathies: The mode calculated in t. study was 8 and the median ensued from 6,5...
