The correlation between shoulder pathologies and sleep disorders.

OBJECTIVE: To assess and characterize the correlation between shoulder pathologies and sleep disturbances. METHODS: Participants enrolled into this case-control study were divided into two groups: patients with an established clinical diagnosis of active shoulder pathology (study group), and patients without any shoulder pathology (control group). All patients completed the Insomnia Severity Index (ISI) questionnaire, in addition to questions related to participant demographics, health status, medication, and other known insomnia risk factors. RESULTS: A total of 98 patients were included (46 in the study group and 52 controls). Mean ISI score was significantly higher (indicating more severe insomnia) in the study group versus control group (t[96] = -9.67), even after correcting for confounders (t[53.1] = -8.61). Additionally, in patients with shoulder pathology, those with comorbidities experienced more sleep disturbances than those without comorbidities (ß = 0.36). Lastly, the shoulder pathology group was at a higher risk of having sleep disturbances compared with controls (relative risk 4.86, 95% confidence interval 2.24, 10.55). CONCLUSIONS: Sleep disturbances are more common among patients with shoulder pathologies. Comorbidities and a shorter duration of pathology may predict more severe sleep disturbances.

Treatment of physeal fractures of the distal radius by volar intrafocal Kapandji method: surgical technique.

BACKGROUND: Distal radial physeal fractures with volar displacement are rare. Several methods of operative treatment include volar plate without inserting distal screws, percutaneous technique using two anterior skin incisions and reversed Kapandji technique with pins introduced through a posterior approach and locked at the anterior cortex of the fracture. METHODS: We report three cases along with a literature review of the surgical techniques described in the past and a novel surgical technique for this uncommon fracture termed "Volar Kapandji". RESULTS: All patients had anatomic reduction at the last follow-up radiography, and all patients had a full range of motion and VAS 0 at the last follow-up. No complications were recorded. CONCLUSIONS: This case study presents the minimally invasive option for treating rare cases of physeal distal radius fractures with volar displacement. LEVEL OF EVIDENCE: V.

Treatment of intra-articular distal radius fractures by the volar intrafocal Kapandji method: a case series.

At present, the most common treatment for intra-articular fractures with a volar fragment is open reduction and internal fixation with a volar locking plate. This manuscript describes and evaluates the safety and efficacy of a modified Kapandji technique with insertion of a volar Kirschner wire for osteosynthesis of intra-articular distal radius fractures with a volar fragment. Four patients treated with the "volar Kapandji technique" completed follow-up of at least 12 (12 to 54) months. The mean age was 43 (23 to 53) years. The mean Disability of the Arm, Shoulder, and Hand score was 21.7 (0 to 41) and the mean Patient-Rated Wrist Evaluation score was 12.9 (0 to 25.8). The mean loss of flexion was 13.7 (0 to 30) degrees, the mean loss of extension was 10 (0 to 30) degrees, the mean loss of supination was 0 degrees, and the mean loss of pronation was 10 (0 to 20) degrees. There was no loss in dorsal angulation, radial inclination, or radial length compared with the other hand. No early or late complications were recorded.

Nail puncture wound through a rubber-soled shoe: a retrospective study of 96 adult patients.

Nail punctures through rubber-soled shoes expose the foot to the possibility of deep infection and foreign body retention. In this article, we describe characteristics of adult patients who sustained nail puncture wounds through a rubber-soled shoe and were treated at our institution from January 1, 2000, to January 8, 2008. Of the 96 patients, 36 (37.5%) were treated conservatively and 60 (62.5%) were treated surgically in the operating room. Of those treated surgically, 15 (25%) had a foreign body extracted during the operation. The operated group had a longer duration of time from injury to hospital admission than did the nonoperated group (5.0 +/- 6.8 days versus 2.7 +/- 3.8 days, P < .05). Treatment success was observed in 91 (94.8%) of the patients, and the median lag time before admission for the less successfully treated group was longer than that for the successfully treated group (10 days versus 2 days, P < .002); and, the less successfully treated group was more likely to receive antibiotics in the community before hospitalization (100.0% versus 47.2%, P < .06), and was more likely to be diabetic (40.0% versus 9.9%, P < .10). Fever, white blood cell count, and erythrocyte sedimentation rate were not significantly associated with treatment outcome. Success of the treatment did not depend on white blood cell count, erythrocyte sedimentation rate, or fever. Ultrasonography was useful in detecting the presence of a foreign body.

Treatment of nonunions with irretrievable broken nail pieces in the distal fragment.

INTRODUCTION: We present our experience in the treatment of nonunited fractures of long bones in the presence of a retained fragment of the broken intramedullary nail. MATERIALS AND METHOD: Of 287 long bone fractures treated by intramedullary fixation, we recalled 5 patients with broken intramedullary nails. In two patients the distal fragments of broken nails were not extracted and refixation was performed by an Ilizarov ring fixation with the broken piece left in situ. RESULTS: The patients ambulated with full weight bearing immediately following surgery. We achieved good results in both patients with fracture union times between 16 and 22 weeks. No complication was observed. CONCLUSIONS: Ring fixation using thin wires or half pins inserted beside fragments of the broken nail provides a simple and minimally traumatic method of treatment in patients when encountering difficulties extracting a retained fragment of broken intramedullary nails.