RESUMO
Over a 4-year period, 218 mallet fractures in 211 adult patients were treated using a custom-made thermoplastic splint. Clinical results were collected prospectively, including the visual analogue score for pain, the range of motion and extensor lag, and the Patient Evaluation Measure (PEM). The joints were congruent in 168 and subluxed in 50. There were no differences in range of movement, extensor lag or PEM associated with articular subluxation or the size of the articular fragment. Pre-existing joint degeneration did not influence outcome. Non-surgical treatment demonstrates predictably good outcomes regardless of fragment size or subluxation in most patients and should be considered when discussing treatment for patients with bony mallet fractures.Level of evidence: III.
Assuntos
Traumatismos dos Dedos , Fraturas Ósseas , Traumatismos dos Tendões , Adulto , Traumatismos dos Dedos/terapia , Articulações dos Dedos , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Amplitude de Movimento Articular , Contenções , Traumatismos dos Tendões/terapia , Resultado do TratamentoRESUMO
We report six cases of complications from use of a thermal wand at wrist arthroscopy. Complications included skin necrosis, extensor tendon lesions and thermal articular cartilage damage, one with a catastrophic outcome. Thermal wands have the potential for substantial soft tissue damage causing severe harm to patients. The damage could be related to the design of the wands. User error poses an additional risk. These risks need to be appreciated and should be minimized. The complications indicate the need for careful use of the thermal wands to minimise risk including using only short bursts of thermal energy, the use of high flow irrigation with an outflow and trying to ensure that the collar of the device and not just the tip is within the joint. In addition, the design of thermal wands for use in the wrist may need to be reviewed.Level of evidence: IV.
Assuntos
Cartilagem Articular , Traumatismos do Punho , Artroscopia , Cartilagem Articular/cirurgia , Humanos , Tendões , Punho , Traumatismos do Punho/cirurgia , Articulação do Punho/cirurgiaAssuntos
Procedimentos Cirúrgicos Eletivos , Controle de Acesso , Medicina Estatal/economia , Medicina Estatal/legislação & jurisprudência , Confiabilidade dos Dados , Procedimentos Cirúrgicos Eletivos/economia , Medicina Baseada em Evidências , Financiamento Governamental , Humanos , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Reino UnidoRESUMO
We describe the treatment of 101 patients with 113 fractures of the proximal phalanx at the junction of the diaphysis with the proximal metaphysis. Fractures were stabilized using a single extra-articular percutaneous Kirschner wire passed lateral to the metacarpal head into the base of the phalanx base and across the fracture to engage the lateral cortex. Patients were treated semi-electively on a day surgery unit. The metacarpophalangeal joint was splinted in flexion with mobilization of the proximal inter-phalangeal joints, until the wire was removed at 24 days and the hand then freely mobilized. The mean total active movement was 230° and no patients experienced problems with significant pain. There were two pin site infections. There were no cases of angular or rotational malunion. These injuries can be successfully and safely treated using this simple technique, negating the need for close monitoring for angular displacement of the fracture, which is frequently seen with non-surgical management. LEVEL OF EVIDENCE: IV.
