RESUMEN
BACKGROUND: Osteoid osteoma (OO) is a slowly progressing benign osteoblastic tumour. In the hand, this tumour is rare. We propose a review of seventeen cases of OO of the phalanx and metacarpal bone. PATIENTS AND METHODS: During the period, between 1998 and 2011, a total of seventeen OO in the hand were confirmed by the pathological examination. They were 10 women and 7 men with an average age of 29 years (age range 17-76). The most common site of the tumour was the proximal phalanx in ten cases, followed by middle phalanx in four cases and metacarpal bone in three cases. The diagnosis of OO was highly required by clinical history. Standard radiographs showed variable images, but computed tomography, and it was useful to facilitate diagnosis and pre-operative planning. All patients underwent surgery (the tumour resection and autogenous bone grafting). In post-operative, there was an immediate pain relief with complete resolution of all symptoms. No recurrence was observed during the last follow-up period of 4 years and 2 months. CONCLUSION: The diagnosis of OO of the hand can be difficult, and it should be considered with bony pain or bony swelling, especially when the history is a chronic one. The CT scan allows visualisation and precise localisation of such benign tumour of the hand. The care should be taken to make the excision complete in order to avoid recurrence.
Asunto(s)
Neoplasias Óseas/diagnóstico , Neoplasias Óseas/cirugía , Falanges de los Dedos de la Mano , Huesos del Metacarpo , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/cirugía , Adolescente , Adulto , Anciano , Femenino , Falanges de los Dedos de la Mano/cirugía , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Huesos del Metacarpo/patología , Huesos del Metacarpo/cirugía , Persona de Mediana Edad , Procedimientos Ortopédicos/métodos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Ewing's sarcoma of the finger is extremely rare. Pain and swelling of the affected finger are the most frequent presenting features. We report two cases of Ewing's sarcoma located at ring finger and the thumb in two children aged 14 and 10 years. The first patient died of generalised metastases despite surgery, chemotherapy and radiation therapy. The second had no localised recurrence or metastases after surgery and chemotherapy at last follow-up of 4.5 years after tumour resection. The tumour's surgical accessibility, chemotherapy, and radiation therapy improve the prognosis of this tumour.
Asunto(s)
Amputación Quirúrgica/métodos , Antineoplásicos/uso terapéutico , Neoplasias Óseas/terapia , Dedos/cirugía , Sarcoma de Ewing/terapia , Adolescente , Neoplasias Óseas/diagnóstico , Niño , Resultado Fatal , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Recurrencia Local de Neoplasia , Radioterapia Adyuvante , Sarcoma de Ewing/diagnósticoRESUMEN
The intraosseous capillary haemangioma is classified as a benign vascular bone tumor. It is extremely rare in the hand. We present the case of a carpometacarpal capillary haemangioma involving the capitate and the bases of third and fourth metacarpals. To our knowledge it is the first case reported at this site.
Asunto(s)
Neoplasias Óseas/cirugía , Hueso Grande del Carpo , Hemangioma Capilar/cirugía , Huesos del Metacarpo , Adulto , Neoplasias Óseas/diagnóstico , Hueso Grande del Carpo/cirugía , Estudios de Seguimiento , Hemangioma Capilar/diagnóstico , Humanos , Masculino , Huesos del Metacarpo/cirugía , Enfermedades Raras , Resultado del TratamientoRESUMEN
INTRODUCTION: Knee arthrodesis is one of the reconstruction options for limb preservation after malignant tumor resection. Vascularised rotatory fibular transfer allows biological and, thus,definitive reconstruction. The goal of this work was to analyse the results of knee arthrodesis with vascularised fibular graft after tumor resection and to discuss the reliability of this technique. PATIENTS AND METHODS: We report a retrospective series of 13 patients with an average age of 29.6 years. The pathological diagnosis was bone sarcoma in 12 cases and synovial chondrosarcoma in one case. Resection/arthrodesis was undertaken as the primary procedure in 11 cases.In two cases, arthrodesis was indicated after failure of an endoprosthesis. Reconstruction was achieved with a vascularised fibular rotatory transfer in all cases. For stabilisation, an external fixator was utilised in eight cases, a femorotibial nail in three cases, and a plate in two cases.Mean follow-up was 6 years. RESULTS: We encountered infection in 53% of cases, mechanical complications in 53% of cases,and nerve palsy in 23% of cases. Four patients died from metastases (only one had arthrodesis complete union). In the nine surviving patients, arthrodesis was fully united in seven cases,after an average period of 36 months. The functional score average (Enneking classification)was 20 points. DISCUSSION: Knee arthrodesis after tumor resection is a complex technique. Septic complications and mechanical failure are frequent regardless of the technique employed. They are related to the extent of bone sacrifice but also to that of soft tissues. The use of vascularised fibula alone and stabilisation by external fixation were the main shortcomings in this series. TYPE OF STUDY RETROSPECTIVE: Level IV.
Asunto(s)
Artrodesis/métodos , Neoplasias Óseas/cirugía , Peroné/trasplante , Sarcoma/cirugía , Adolescente , Adulto , Niño , Femenino , Peroné/irrigación sanguínea , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The median nerve entrapment after elbow-dislocation is rare. We report two cases of fracture dislocation elbow completed by entrapment of median nerve occurred after reduction in two children. For both cases, the diagnosis of entrapment was made some months later after injury. Median nerve graft was performed after nerve resection. The nerve recovery was satisfactory at the final follow-up. This nerve complication should be suspected systematically before and after reduction of all dislocation of the elbow in the children. The indication of nerve release or nerve graft depends on the entrapment and the delay of the palsy.
Asunto(s)
Lesiones de Codo , Fracturas Óseas/complicaciones , Luxaciones Articulares/complicaciones , Neuropatía Mediana/etiología , Síndromes de Compresión Nerviosa/etiología , Niño , Articulación del Codo/cirugía , Femenino , Fracturas Óseas/terapia , Humanos , Luxaciones Articulares/terapia , Masculino , Neuropatía Mediana/diagnóstico , Neuropatía Mediana/cirugía , Síndromes de Compresión Nerviosa/diagnóstico , Síndromes de Compresión Nerviosa/cirugía , Nervio Sural/trasplanteRESUMEN
Chondromyxoid Fibroma is a rare benign osseous tumor especially in the hand, because the hand represents less than 3% of all osseous locations. It can causes problems of differential diagnosis with several types of tumors and in particular with chondrosarcoma, for which the management is totally different. We report a case of location of a chondromyxoid fibroma in a phalanx of the thumb, which caused problems of differential diagnosis with chondroma and chondrosarcoma. There were 2 recurrences after local excision. A wide resection with massive cancellous aotograft prevented further recurrence and the patient is disease free with a follow up of 7.5 years.
Asunto(s)
Neoplasias Óseas/patología , Condroblastoma/patología , Fibroma/patología , Pulgar/patología , Neoplasias Óseas/cirugía , Niño , Condroblastoma/cirugía , Fibroma/cirugía , Humanos , Masculino , Pulgar/cirugíaRESUMEN
The authors report their experience of digital lengthening and analyze the indications and results of 12 cases performed over 13 years in the plastic and reconstructive surgery service of the Kassab institute. Distraction was performed using a mini-orthofix device. In majority of cases, the procedure was performed on young people, manual workers and victims of industrial accidents. The lengthened osseous segment was the 1st metacarpal in 7 cases, the proximal phalanx of the index in 3 cases, the 3rd metacarpal once and the proximal phalanx of the middle finger in one case. Gradual distraction at the rate of 0.25 to 0.5 mm/day was carried out in 10 cases using the procedure of "callotasis". In 2 cases the distraction was performed at a rate of 1 mm/day followed by bone graft. Callotasis allowed us to obtain an average lengthening of 17 mm (61.5%) in distraction of the phalanx, and 26 mm (63.3%) in distraction of the first metacarpal. This technique avoids the spontaneous shortening observed after the use of bone graft alone. Complications are relatively frequent but had little influence on the final result.
Asunto(s)
Dedos/patología , Traumatismos de la Mano/terapia , Osteogénesis por Distracción/métodos , Adolescente , Adulto , Trasplante Óseo , Femenino , Traumatismos de la Mano/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The authors report 5 cases of chondrosarcoma of the hand brought together over a period of 20 years. The series comprises 3 men and 2 woman of average age 42 years. In two cases the tumour arose from degeneration in a preexisting lesion of Ollier's disease. Diagnosis was made on clinical and radiological criteria. Confirmation of the diagnosis by histological examination proved to be difficult in 2 cases. The treatment was surgical, with ray amputation in 3 cases and curettage with bone graft in the other 2. None of the patients had a recurrence at 4.5 years mean follow-up.
Asunto(s)
Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Adolescente , Adulto , Anciano , Amputación Quirúrgica , Neoplasias Óseas/diagnóstico por imagen , Trasplante Óseo , Condrosarcoma/diagnóstico por imagen , Legrado , Diagnóstico Diferencial , Encondromatosis/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , RadiografíaRESUMEN
The strange body at the hand level is frequent consultation pattern. Its extraction seems easy, however it's not. The authors reported one observation of the hand which is penetrated by a ig strange body. It's ablation is performed in a surgical room under anaesthesia, respecting the tension lines at the hand level and avoiding the nerves ramification of the cubital nerve that was hung by the harpoon.
Asunto(s)
Cuerpos Extraños/cirugía , Mano , Anciano , Disección/métodos , Cuerpos Extraños/etiología , Mano/inervación , Humanos , Masculino , Derivación y Consulta/estadística & datos numéricosRESUMEN
We have analysed 283 patient studies operated of ambulatory during the last two years. These patients represent only 12% of the patient group. It's especially a matter of patients operated urgently. The local anaesthesia in the regional local was practised in terms of 90% of cases. The complications where exceptional. We wanted to insist on the necessary guidelines and pitfalls to forget during the practice of that surgery and we wanted to focus on its advantages.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Cirugía Plástica/organización & administración , Procedimientos Quirúrgicos Ambulatorios/economía , Procedimientos Quirúrgicos Ambulatorios/métodos , Anestesia/economía , Anestesia/métodos , Anestesia/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , TúnezAsunto(s)
Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Síndrome del Túnel Carpiano/cirugía , Traumatismos de la Mano/cirugía , Mano/cirugía , Infecciones/cirugía , Neoplasias/cirugía , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Procedimientos Quirúrgicos Ambulatorios/métodos , Procedimientos Quirúrgicos Ambulatorios/tendencias , Costos de Hospital/estadística & datos numéricos , Humanos , Admisión del Paciente/estadística & datos numéricos , Admisión del Paciente/tendencias , Atención Perioperativa/métodos , Cuidados Preoperatorios/métodos , Evaluación de Programas y Proyectos de Salud , TúnezAsunto(s)
Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Mano , Tendinopatía/diagnóstico , Tendinopatía/terapia , Tenosinovitis/diagnóstico , Tenosinovitis/terapia , Muñeca , Antiinflamatorios/uso terapéutico , Traumatismos en Atletas/etiología , Humanos , Aparatos Ortopédicos , Examen Físico , Modalidades de Fisioterapia , Derivación y Consulta , Esteroides , Tendinopatía/etiología , Tenosinovitis/etiologíaRESUMEN
INTRODUCTION: In this study, the authors have described an original technique for the two-stage treatment of trans-scaphoid perilunar dislocation. PATIENTS AND METHODS: In this study, the first step consisted of reducing the extent of the perilunar displacement, followed one month later by percutaneous pinning of the scaphoid as described by Galluccio. A series of 20 cases was treated in this manner, with positive results regarding scaphoid stabilization, joint mobility and the state of the median nerve. CONCLUSION: The advantage of this technique is that it avoids emergency stabilization of the scaphoid, a procedure which may be complicated by accompanying carpal injuries.
Asunto(s)
Clavos Ortopédicos , Luxaciones Articulares/cirugía , Hueso Semilunar , Manipulación Ortopédica/métodos , Articulación de la Muñeca , Adulto , Fenómenos Biomecánicos , Estudios de Seguimiento , Fuerza de la Mano , Humanos , Luxaciones Articulares/clasificación , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/etiología , Luxaciones Articulares/fisiopatología , Masculino , Manipulación Ortopédica/instrumentación , Radiografía , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
From 1985 to 1997, 74 patients was operated of scaphoid non union at the Kassab Institute by a percutaneous pinning as described by Galluccio. The average age is 30 years with an extreme from 17 to 48 years. Union was obtained after an average of two years and six months. In 12 cases the delay was superior than three years. Functionally, pain is a constant cause of consultations and the majority of patients presented a reduction of the mobility sector (80%) and the strength of grasp (70%). Anatomically, it is particularly a pseudarthrosis stage II a of Alnot, and type I b of our classification. An immobilisation post-operative during one month is the rule. The analysis of results at an average of four years, revealed 91% of clinical recovery. Radiographically, the union is obtained in 89% of cases. Our fails (11%), are explained by an inadequate mounting and particularly by the length of pseudarthrosis. Compared to other means of synthesis, the percutaneous pinning of Galluccio, is an inexpensive technique, easily and rapid, which permit to obtain an interesting results particularly in the recent pseudarthrosis (evolution delay below three years).
Asunto(s)
Clavos Ortopédicos , Huesos del Carpo/cirugía , Seudoartrosis/cirugía , Adolescente , Adulto , Artralgia/fisiopatología , Huesos del Carpo/lesiones , Moldes Quirúrgicos , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Curación de Fractura , Fuerza de la Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Seudoartrosis/clasificación , Seudoartrosis/fisiopatología , Rango del Movimiento Articular/fisiología , Resultado del Tratamiento , Articulación de la Muñeca/fisiopatologíaRESUMEN
The authors reports the experience of the plastic surgery unit in the Kassab's Institute of Orthopedics in Tunis. This series consists of 44 cases of polydactyly dominated by duplication of the little finger and the thumb. A slight male predominance was observed and the mean age at surgery was 8 years. Two types of polydactyly were observed: simple, such as rudimentary digits, complex, with associated bone malformation or syndactyly. In ulnar polydactyly, associated duplication of the toes in frequently noted. The most frequent surgical approach was amputation of the more dystrophic finger with reconstruction and correction of the other congenital malformation observed. Some cases of digital redistribution were also performed. A review of the literature is presented together with an objective analyse of esthetic and functional results.