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1.
JSES Rev Rep Tech ; 4(2): 196-203, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38706679

RESUMO

Background: Despite surgical reestablishment of the supporting structures, instability may often persist in traumatic elbow injury. In these cases, a temporary internal or external fixator may be indicated to unload the repaired structures and maintain joint concentricity. Aggregate data are needed to characterize the risk of complication between external fixation (ExFix) and the internal joint stabilizer (IJS) when used for traumatic elbow instability. Our objective was to review the literature to compare the complication profile between external fixation and the IJS. Methods: A database query was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The Population, Intervention, Comparison and Outcome characteristics for eligibility were the following: for patients over 18 years clinical outcomes were compared between an ExFix or the IJS for acute or chronic elbow instability. The Cochran risk of bias in nonrandomized studies of interventions and grades of recommendation, assessment, development, and evaluation framework were compiled for risk of bias and quality assessment. Results: The rate of recurrent instability was 4.1% in the IJS group (N = 171) and 7.0% in the ExFix group (N = 435), with an odds ratio of 1.93 (95% confidence interval 0.88-4.23). The rate of device failure was 4.4% in the IJS group and 4.1% in the ExFix group. Pin-related complications occurred in 14.6% of ExFix cases. Complications in the IJS group were the following: 1 case of inflammatory reaction, 4 cases of post removal surgical site infection, and 5 symptomatic removals. Discussion: The literature demonstrates a distinct difference in complication profile between external fixation and the IJS when used as treatment for traumatic elbow instability. Although not statistically significant, the higher rate of recurrent instability following external fixation may be clinically important. The high rate of pin-related complications with external fixation is notable.

2.
J Hand Surg Eur Vol ; 48(2_suppl): 4S-10S, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37704024

RESUMO

The scaphoid is the largest of the carpal bones, articulating with both proximal and distal carpal rows. If scaphoid fractures are not appropriately diagnosed and treated, there is a risk of nonunion, osteonecrosis and degenerative arthritis. Operative management of the scaphoid fracture is primarily determined by the fracture location and amount of displacement. There is increased momentum for dual screw fixation constructs, intended to provide greater stability and reduce the risk of nonunion. Our current practice is to utilize two screws without graft as a first-line treatment for scaphoid nonunion with or without humpback deformity and cyst formation. This review will discuss the management of acute scaphoid fractures and the treatment of nonunion.


Assuntos
Fraturas Ósseas , Traumatismos da Mão , Osso Escafoide , Traumatismos do Punho , Humanos , Fraturas Ósseas/cirurgia , Osso Escafoide/cirurgia , Extremidade Superior
3.
Tech Hand Up Extrem Surg ; 27(4): 214-219, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37439145

RESUMO

We describe a medial approach to the coronoid where the flexor-pronator mass is released from its humeral origin by creating a proximally based tendinous flap. This technique facilitates access to the coronoid, preservation of the medial collateral ligament origin, and repair of the flexor-pronator mass. This approach has utility for all coronoid fracture variations but especially the O'Driscoll anteromedial subtype 3, which includes fractures of the sublime tubercle, the anteromedial facet, and the coronoid tip.


Assuntos
Articulação do Cotovelo , Fraturas Ósseas , Fraturas da Ulna , Humanos , Fraturas da Ulna/cirurgia , Articulação do Cotovelo/cirurgia , Fraturas Ósseas/cirurgia , Úmero , Fixação Interna de Fraturas/métodos
4.
Injury ; 54(10): 110931, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37495450

RESUMO

INTRODUCTION: Concerning rates of nonunion in articular distal humerus fractures indicate an unsolved problem. The fixation principles of O'Driscoll describe linking the fractured articular segment to the distal humerus columns with compression screws which creates a stable fixed angle construct. A novel device has been introduced which utilizes an interlocking beam through the articular segment to connect the distal aspect of the medial and lateral plates, creating a linked construct. We sought to evaluate the stability of this linked construct using an articular model of distal humerus fracture. MATERIALS AND METHODS: Ten matched pair specimens of 65 years of age or older were randomized to the use (LB group) or non-use (NLB group) of an interlocking beam to link the medial and lateral locking plates in fixation of an AO Type C3 fracture model. Outside of the linking beam, fixation between the matched pairs was consistent using 2.7 mm locking screws distally with fixed trajectories and +/- 2 mm lengths. RESULTS: Mean stiffness was 273 Newtons/mm in the LB group and 225 Newtons/mm in the NLB group (p = 0.001). Mean maximum displacement was 0.28 in the LB group and 0.93 mm in the NLB group (p = 0.006). Mean load to failure was 277 pounds in the LB group and 280 pounds in the NLB group (p = 0.94). DISCUSSION: Our results indicate that an interlocking beam which links the medial and lateral plates provides greater stability compared to a similar construct without an interlocking beam. We attribute this finding to the beam's double supported design which resists cantilever bending and provides robust compression of the fractured fragments.


Assuntos
Fraturas Distais do Úmero , Fraturas Intra-Articulares , Humanos , Fenômenos Biomecânicos , Placas Ósseas , Fixação de Fratura , Fixação Interna de Fraturas/métodos , Úmero , Fraturas Intra-Articulares/diagnóstico por imagem , Fraturas Intra-Articulares/cirurgia
5.
Tech Hand Up Extrem Surg ; 26(4): 214-217, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383724

RESUMO

A variety of fixation options exist for treatment of unstable proximal phalanx fractures. Variables which require consideration include the strength of fixation, the invasiveness of the technique and the postoperative rehabilitation protocol. Here we present a minimally invasive technique for dual headless compression screw fixation of proximal phalanx fractures which reduces extensor tendon violation and allows early motion in the immediate postoperative period.


Assuntos
Falanges dos Dedos da Mão , Fraturas Ósseas , Humanos , Falanges dos Dedos da Mão/cirurgia , Amplitude de Movimento Articular , Parafusos Ósseos , Fraturas Ósseas/cirurgia , Tendões , Fixação Interna de Fraturas/métodos
6.
J Orthop Trauma ; 35(Suppl 3): s21-s26, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415878

RESUMO

SUMMARY: Imaging of the distal radius is of paramount importance in diagnosing injuries, indicating patients for operative or nonoperative treatment, and appropriately following patients for associated injuries and complications. Plain radiographs and fluoroscopy are the dominant imaging modalities in all settings because they are readily available and provide valuable information about the osseous structures and any instrumentation. Computed tomography can offer more information about implant placement and the level of comminution of the articular surfaces but is more expensive and exposes patients to higher doses of radiation. Magnetic resonance imaging is less commonly used but is useful for occult fractures and other associated injuries. Ultrasonography is gaining popularity in evaluating implant placement, especially regarding tendon impingement and subsequent tendon injury.


Assuntos
Fraturas do Rádio , Rádio (Anatomia) , Humanos , Imageamento por Ressonância Magnética , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Tomografia Computadorizada por Raios X
7.
Hand (N Y) ; 10(3): 547-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26330793

RESUMO

Hibernomas are rare, benign tumors of brown adipose tissue. While they have been found in a variety of locations, they are rare in the upper extremity and not previously described in the hand. Diagnosis is most often made histologically, and treatment consists of surgical resection. We present an unusual case of hibernoma in the hand treated with marginal excision, resulting in good function, cosmesis, and no recurrence.

8.
Hand (N Y) ; 10(2): 248-53, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26034439

RESUMO

BACKGROUND: Assessment of joint range of motion (ROM) is an accepted evaluation of disability as well as an indicator of recovery from musculoskeletal injuries. Many goniometric techniques have been described to measure ROM, with variable validity due to inter-rater reliability. In this report, we assessed the validity of photograph-based goniometry in measurement of ROM and its inter-rater reliability and compared it to two other commonly used techniques. METHODS: We examined three methods for measuring ROM in the upper extremity: manual goniometry (MG), visual estimations (VE), and photograph-based goniometry (PBG). Eight motions of the upper extremity were measured in 69 participants at an academic medical center. RESULTS: We found visual estimations and photograph-based goniometry to be clinically valid when tested against manual goniometry (r avg. 0.58, range 0.28 to 0.87). Photograph-based measurements afforded a satisfactory degree of inter-rater reliability (ICC avg. 0.77, range 0.28 to 0.96). CONCLUSIONS: Our study supports photograph-based goniometry as the new standard goniometric technique, as it has been clinically validated, is performed with greater consistency and better inter-rater reliability when compared with manual goniometry. It also allows for better documentation of measurements and potential incorporation into medical records in direct contrast to visual estimation.

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