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1.
Maedica (Bucur) ; 19(1): 177-181, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38736932

RESUMO

Background: Enchordoma of the distal phalange of the thumb is extremely rare. Case presentation: We report a case of 31-year-old man who presented with a pathological fracture of the left thumb. Imaging evaluation revealed a lytic lesion and surgical curettage with bone graft was performed after fracture healing. Histological examination confirmed the diagnosis of enchordoma. The postoperative period was uncomplicated without signs of recurrence. Conclusion:Lytic lesions in the thumb are uncommon occurrences and necessitate a comprehensive examination to determine their potential causes. Given the significant functional role of the thumb compared to other fingers, it is crucial to undergo radiological assessment and further investigation of these lytic lesions.

2.
J Clin Med ; 12(2)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36675510

RESUMO

The aim of this review and meta-analysis is to assess recent clinical trials concerning the combination of operative treatment of rotator cuff tears and the administration of PRP and its effect on clinical scores and postoperative retear rates. The trials were used to compare the combination of PRP treatment and arthroscopic rotator cuff repair to arthroscopy alone. Twenty-five clinical trials were reviewed. A risk-of-bias assessment was made for all randomized clinical trials included, using the Cochrane collaboration's tool as well as a quality assessment for all non-randomized studies utilizing the Newcastle−Ottawa scale. The PRP-treated patients showed statistically significant improvement postoperatively compared to control groups concerning the Constant−Murley (mean difference 2.46, 95% CI 1.4−3.52, p < 0.00001), SST (mean difference 0.32, 95% CI 0.02−0.63, p = 0.04), and UCLA (mean difference 0.82, 95% CI 0.23−1.43, p = 0.07) scores. A statistically significant decrease of retear rates in the PRP-treated patients, with a risk ratio of 0.78 (95% CI 0.65−0.94, p = 0.01), was found. We believe that the results presented have positive aspects, especially concerning the retear risk, but are yet inconclusive concerning clinical results such as shoulder pain and function.

3.
Instr Course Lect ; 70: 73-84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438905

RESUMO

The carpal and cubital tunnel syndromes are the most common compression neuropathies of the upper extremity. Although the diagnosis and management of these neuropathies have evolved over the past few decades, the ideal primary surgical treatment has not yet been established and management of recurrence remains a challenge. Revision surgery with simple repeated nerve decompression even accompanied by neurolysis does not always result in satisfactory clinical outcomes. Coverage with soft tissue or wrapping of the nerve with biologic or synthetic protective barriers can be used as an ancillary technique in the revision surgery to enhance nerve healing, preventing perineural scarring and adhesions. Future randomized larger trials combined with better understanding of nerve biology may be necessary to optimize primary and revision surgical treatment for carpal and cubital tunnel syndrome.


Assuntos
Síndrome do Túnel Carpal , Síndrome do Túnel Ulnar , Síndromes de Compressão Nervosa , Síndrome do Túnel Carpal/diagnóstico , Síndrome do Túnel Carpal/cirurgia , Síndrome do Túnel Ulnar/diagnóstico , Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica , Humanos , Síndromes de Compressão Nervosa/cirurgia , Reoperação , Extremidade Superior/cirurgia
4.
Hand Clin ; 23(2): 153-63, v, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17548007

RESUMO

In 1934, fractures of the middle and distal third of the radius associated with instability of the distal radial ulnar joint (DRUJ) were described by Galeazzi. This type of lesion is characterized by its unstable nature and the need for open reduction and internal fixation to achieve a satisfactory functional outcome. A high index of suspicion should be maintained by the surgeon, and a thorough examination for instability of the DRUJ must be conducted. The marked instability of this fracture-dislocation complex is further enhanced by the disruption of the triangular fibrocartilage complex, either with or without ulna styloid fracture. Treatment in adults is surgical, and both bone and soft tissue injuries should be addressed.


Assuntos
Luxações Articulares/diagnóstico , Luxações Articulares/terapia , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/terapia , Articulação do Punho , Moldes Cirúrgicos , Diagnóstico por Imagem , Fixação Interna de Fraturas , Humanos , Imobilização , Luxações Articulares/classificação , Luxações Articulares/complicações , Instabilidade Articular/etiologia , Instabilidade Articular/terapia , Cuidados Pós-Operatórios , Fraturas do Rádio/classificação , Fraturas do Rádio/complicações
5.
J Hand Surg Am ; 31(3): 418-24, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16516736

RESUMO

PURPOSE: For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure. METHODS: Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results. RESULTS: The mean follow-up period was 33 months (range, 12-76 mo). Three patients had subsequent surgery 9 to 11 months after the procedure. Subsequent surgeries included a dorsal capsulodesis, a four-corner fusion, and a wrist arthrodesis. Of the 8 remaining patients there were 2 excellent, 4 good, 1 fair, and 1 poor result based on the Mayo wrist score. In these patients the mean range of motion was 65 degrees of extension to 59 degrees of flexion and the mean grip strength was 82% of the uninjured contralateral extremity. Although persistent radiographic SL gapping in grip views was noted in all 8 patients none progressed to static instability or dorsal intercalated segment instability. CONCLUSIONS: The results of this technique are suboptimal; however, it may be an option for patients unwilling to have more than an arthroscopic procedure or those requiring maintenance of wrist motion, provided they understand the risks and benefits of this approach. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.


Assuntos
Artroscopia , Pinos Ortopédicos , Desbridamento , Instabilidade Articular/cirurgia , Osso Semilunar/cirurgia , Osso Escafoide/cirurgia , Adulto , Articulações do Carpo/diagnóstico por imagem , Articulações do Carpo/fisiopatologia , Articulações do Carpo/cirurgia , Doença Crônica , Feminino , Seguimentos , Força da Mão/fisiologia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/fisiopatologia
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