ABSTRACT
Metacarpal malunion with significant angulation leading to symptoms from bony prominence in the palm or dorsum and decreased grip strength occur rarely, but may lead to patients requiring surgical correction. Corrective osteotomy procedures with plate fixation are commonly performed for these patients. Localizing the correct site of osteotomy and the required amount of bone removal for precise correction is difficult even with adequate preoperative planning. After osteotomy, plate osteosynthesis is the most common fixation method to allow for early mobilization; however, plate osteosynthesis can lead to soft tissue irritation, which may necessitate secondary surgeries for tenolysis and implant removal. This case study highlights our use of an intramedullary wire as an additional guide to the ideal site of osteotomy and then the use of an intramedullary screw for stabilization of the osteotomy site.
Subject(s)
Bone Wires , Fracture Fixation, Internal/methods , Fractures, Malunited/surgery , Metacarpal Bones/surgery , Osteotomy/methods , Humans , Male , Metacarpal Bones/injuries , Reoperation , Young AdultABSTRACT
BACKGROUND: To evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation. MATERIALS AND METHODS: A total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients' treatment costs, median salaries and lengths of medical leave were obtained. RESULTS: DASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52). CONCLUSION: Our study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option. LEVEL OF EVIDENCE: Level 3.
Subject(s)
Fracture Fixation/methods , Intra-Articular Fractures/therapy , Radius Fractures/therapy , Adult , Aged , Bone Plates , Casts, Surgical/economics , Conservative Treatment/economics , Conservative Treatment/methods , Female , Fracture Fixation/economics , Fracture Fixation, Internal/economics , Fracture Fixation, Internal/methods , Humans , Intra-Articular Fractures/economics , Intra-Articular Fractures/surgery , Male , Middle Aged , Radius Fractures/economics , Radius Fractures/surgery , Treatment Outcome , Young AdultABSTRACT
<p><b>INTRODUCTION</b>Hand tumours are frequently encountered in clinical practice. A list of differential diagnoses of the most common hand tumours based on anatomical location would be helpful for clinicians. We aimed to determine the anatomical distribution of hand tumours seen at a hand surgery practice in Singapore.</p><p><b>METHODS</b>The medical records of 50 men and 65 women (mean age 41.7 [range 17-74] years) who underwent excision of hand tumours between 1 June 2010 and 31 December 2012 were reviewed. The histological diagnoses and anatomical locations of the tumours were analysed. The locations were divided into three main groups: (a) distal to the metacarpophalangeal joints (MCPJs); (b) between the MCPJs and carpometacarpal joints (CMCJs); and (c) between the CMCJs and the radiocarpal joint (RCJ).</p><p><b>RESULTS</b>Overall, the most common tumours excised from the hand were ganglions (n = 66/116, 56.9%) and giant cell tumours of the tendon sheath (GCTTSs; n = 11/116, 9.5%). However, distal to the MCPJs, GCTTSs (n = 11/39, 28.2%) were more common than ganglions (n = 7/39, 17.9%). Most of the ganglions (n = 59/66, 89.4%) arose from between the CMCJs and RCJ.</p><p><b>CONCLUSION</b>Most hand tumours were benign. Ganglions were the most common tumours between the CMCJs and RCJ, while GCTTSs were the most common tumours distal to the MCPJs.</p>
