RESUMO
Trapezium fractures rarely present as isolated fractures and warrant anatomical fixation to minimize post-traumatic arthritis. Fixation techniques reported include open approach to trapezium fracture and fixation, percutaneous fixation under image intensifier guidance or percutaneous arthroscopic fixation under gravitational traction. We have reported a novel method of percutaneous fixation of a trapezium Walker type IV coronal split fractures under gravitational traction and per-operative image intensifier guidance. Two percutaneous headless differential pitch screws were used for fixation, which was off-loaded using an inter-metacarpal K-wire. Patient was discharged on the same day with a light-weight cast. The fixation yielded acceptable reduction of the articular surface as confirmed by radiographs. The cast and off-loading K-wire were removed at four weeks post-surgery and hand therapy was commenced. 3-month review showed optimal radiological healing with excellent return to function without pain. In conclusion, using gravitational traction can allow percutaneous fixation of trapezium fractures with excellent results and also make an otherwise complex procedure simpler. LEVEL OF EVIDENCE: IV.
Assuntos
Fraturas Ósseas , Traumatismos da Mão , Traumatismos do Punho , Humanos , Fixação Interna de Fraturas/métodos , Tração , Fraturas Ósseas/cirurgia , Fios OrtopédicosRESUMO
The authors report the case study of a 16-year old boy who presented with cyclic vomiting syndrome. His main clinical symptoms had been unpredictable sudden-onset vomiting episodes interrupting long episodes of full health lasting for several months since the patient was a toddler. Histological results of the upper tract endoscopy showed eosinophil gastroenteritis with long-existing, undetected cow milk allergy as the likely underlying reason. The patient became symptomless following the elimination of cow milk from his diet. The symptoms did not recur following a cow milk load test carried out half a year later, and the patient continues to be symptomless after more than one-year of continuous cow milk consumption. In this paper, the authors would like to highlight the importance of EG int the differential diagnosis of any chronic, recidive gastrointestinal symptoms and discuss the likely underlying causes of EG in paediatrics.
