RESUMO
This study attempts to determine changes in carpal canal volume with distraction across the wrist. Uniform longitudinal distraction was maintained with two external fixators on the radial and ulnar aspects of the forearm axis of five cadaver specimens. After CT scanning, volume determinations were made at 5 mm increments beginning at the lunocapitate joint to a point 1.5 cm distal to the middle finger carpometacarpal joint. There was a statistically significant decrease of the mean total carpal canal volume from 0 to 4.54 kg of distraction, with no statistically significant decrease from 0 to 2.27 kg or 2.27 to 4.54 kg. The largest decrease occurred at 15 and 20 mm distal to the proximal edge of the transverse carpal ligament corresponding to the level of the hamate hook. Reduction in mean carpal canal volume was 10.2% and 7.5% at these distances, respectively, from 0 to 4.54 kg of distraction. Progressive distraction across the wrist causes a decrease in total carpal canal volume.
Assuntos
Fixadores Externos , Articulação da Mão/patologia , Articulação da Mão/cirurgia , Ligamentos Articulares/patologia , Osteogênese por Distração/métodos , Idoso , Idoso de 80 Anos ou mais , Cadáver , Articulação da Mão/diagnóstico por imagem , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/cirurgia , Pessoa de Meia-Idade , Tamanho do Órgão , Pressão , Estresse Mecânico , Tomografia Computadorizada por Raios XRESUMO
Fifteen patients over the age of 60 years (average age: 65 years), with 19 digital nerve lacerations, were evaluated more than 1 year after injury. Two-point discrimination, Semmes-Weinstein evaluation, and subjective return of sensibility were examined by a certified hand therapist before and after local anesthetic block of the uninjured digital nerve. Sixty-three percent of the patients regained moving two-point discrimination less than 15 mm; 100 percent regained Semmes-Weinstein values of less than 4.56; and 84 percent of the patients subjectively noted greater than half of their normal sensation. Crossover innervation was a factor in four of 14 repairs. Based on the data, useful sensation can be regained by repairing a digital nerve in the majority of patients older than 60 years of age.
Assuntos
Traumatismos dos Dedos/cirurgia , Dedos/inervação , Lacerações/cirurgia , Idoso , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Bloqueio Nervoso , SensaçãoRESUMO
The thumb, which is normally located on the radial border of the hand, requires adequate sensibility to perceive its environment and adequate mobility to oppose to the other digits. We present a case in which the most ulnar digit of the hand was surgically augmented to function as a thumb.
Assuntos
Dedos/anormalidades , Deformidades Congênitas da Mão/genética , Polegar/anormalidades , Criança , Dedos/diagnóstico por imagem , Dedos/cirurgia , Deformidades Congênitas da Mão/diagnóstico por imagem , Deformidades Congênitas da Mão/cirurgia , Força da Mão/fisiologia , Humanos , Masculino , Destreza Motora/fisiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Polegar/diagnóstico por imagem , Polegar/cirurgiaRESUMO
The treatment of 12 distal radius nonunions in 11 patients over a 24-year period is presented. The average age of the patients was 55 years (range, 35-72 years). The comorbid medical conditions in the patients with these fractures included diabetes mellitus, peripheral vascular disease, psychiatric disorders, alcoholism, peripheral neuropathy, scleroderma, and morbid obesity. Nine of the un-united fractures in 8 patients had insufficient metaphyseal bone to allow internal fixation; 6 of these fractures were treated with a wrist arthrodesis. Three un-united fractures in 3 patients had sufficient supporting bone to permit correction of the nonunion and preservation of the radiocarpal joint. Three nonunions in 3 patients were treated without further surgery. Bony union was achieved in all 9 nonunions managed operatively (6 wrist arthrodeses and 3 open reductions).
Assuntos
Fixação Interna de Fraturas/métodos , Fraturas não Consolidadas/cirurgia , Fraturas do Rádio/cirurgia , Articulação do Punho/fisiopatologia , Adulto , Idoso , Feminino , Seguimentos , Fixação de Fratura/métodos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento , Articulação do Punho/diagnóstico por imagemRESUMO
Primary cutaneous Aspergillus flavus infections of the hand are exceedingly rare. Usually, these infections are present in severely immunocompromised patients suffering from lymphoreticular malignancies. The majority of cases result in invasive systemic infections and often culminate in death. We report a case of primary cutaneous A. flavus infection in the hand of a patient immunocompromised only by non-insulin-dependent diabetes, who ultimately was cured of this infection with oral itraconazole.
Assuntos
Antifúngicos/administração & dosagem , Aspergilose/tratamento farmacológico , Aspergillus flavus , Dermatoses da Mão/tratamento farmacológico , Itraconazol/administração & dosagem , Administração Oral , Humanos , Masculino , Pessoa de Meia-Idade , RecidivaRESUMO
A 25-year-old female with primary malignant fibrous histiocytoma of the distal fibula is presented. Malignant fibrous histiocytoma of bone is a rare primary bone tumor in this anatomic location. Careful preoperative staging studies and neoadjunct chemotherapy permitted an unusual resection to be performed resulting in successful limb salvage for the patient.
