RESUMO
Over a period of 12 years, 104 cases of posttraumatic reflex sympathetic dystrophy have been diagnosed followed up and treated according to a standard protocol, including, among other clinical items, a psychiatric examination. Apart from the traditional clinical recordings, the following has been noted: 1. All patients were over 30 years of age; 2. No relationship was found between the significance of the trauma and the severity of the dystrophy; 3. The dystrophy nearly always emerged at the time of the primary healing of the injury; 4. On psychiatric examination, 96% of the patients showed signs of chronic depression; 5. Forty-nine percent had elevated gamma GT suggestive of alcohol abuse; 6. The socioprofessional context always revealed: either a state of inactivity (jobless persons, disabled persons, childless housewives, pensioners); or an opportunity for inactivity (work injury suffered by workers, lower-rank employees, bankrupt self-employed people). There were no tradesmen, executives, lawyers, physicians, consultants, artists, sportsmen or musicians in the series, and no housewives with young children. 7. In the second phase of the survey, we decided to complement the drug therapy by systematically adding antidepressant agents. This led to a significant improvement in the course of the disease. These elements have led us to consider whether traumatic algodystrophy could be a psychosomatic disease.
Assuntos
Transtorno Depressivo/psicologia , Distrofia Simpática Reflexa/psicologia , Ferimentos e Lesões/psicologia , Adulto , Idoso , Antidepressivos/uso terapêutico , Emprego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicofisiológicos/psicologia , Distrofia Simpática Reflexa/patologia , Classe SocialAssuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Fenilacetatos/uso terapêutico , Propionatos/uso terapêutico , Ciática/tratamento farmacológico , Doença Aguda , Adulto , Idoso , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Ensaios Clínicos como Assunto , Método Duplo-Cego , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Propionatos/administração & dosagem , Propionatos/efeitos adversos , Distribuição AleatóriaAssuntos
Microcirurgia/métodos , Traumatismos dos Tendões/cirurgia , Tendões/cirurgia , Adolescente , Adulto , Idoso , Criança , Feminino , Mãos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The frequency fo secondary displacement in fractures of the distal end of the radius is very high and varies from 40 to 60% in various series. This results from the void in the epiphysis after reduction due to crushing of the cancellous bone. Secondary displacement can be easily avoided by the bipolar fixation method. This method is quite simple. Two strong Kirschner wires are driven into the radius and into the first metacarpal, and then incorporated in the cast after the reduction of the fracture. In this study we have followed 102 out of 250 patients treated by this method. The number of secondary displcements has been negligible. The functional results are excellent and we did not find any untoward effects attributable to our technique.
