RESUMEN
Scapholunate instability can be treated by stabilizing the scaphoid with the dorsal wrist capsule, which acts as a tether to control palmar rotation. We began using suture anchors instead of pull-out wires to secure the dorsal capsule to the scaphoid. Thirty-eight patients were treated with this method, and 35 were followed an average of 24 months. Sixteen were pain free, 12 had pain with activity, and 7 required additional surgical treatment. Patients regained 85% of expected grip strength, with 25 of the 35 returning to their preinjury job. The scapholunate gap, reduced at the time of surgery, recurred in 31 of the 35 patients, but this alone did not correlate with symptoms. This procedure improves symptoms in a majority of patients, but like other procedures described for scapholunate instability, it does not completely cure the problem.
Asunto(s)
Huesos del Carpo/lesiones , Inestabilidad de la Articulación/cirugía , Técnicas de Sutura/instrumentación , Adulto , Femenino , Estudios de Seguimiento , Fuerza de la Mano , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/etiología , Masculino , Radiografía , Rango del Movimiento Articular , Recurrencia , Rotación , Resultado del TratamientoRESUMEN
Mitek (Norwood, MA) bone anchors were used to attach soft tissue to the bones of the hand, wrist, and elbow in 66 procedures (166 anchors). The technical difficulties, initial fixation, long-term stability, and postoperative complications were retrospectively reviewed. The technique was easy to learn and to use. Intraoperatively, secure fixation of soft tissue to bone was accomplished in every case, and follow-up x-ray films showed that 65 of the implants remained securely anchored in bone. The far cortex was penetrated six times, resulting in two complications. The Mitek bone anchor is an excellent technique for achieving soft-tissue fixation in the hand and upper extremity, but penetration of the far cortex should be avoided.
Asunto(s)
Brazo/cirugía , Huesos , Fijadores Internos , Prótesis e Implantes , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ortopedia/métodos , Estudios RetrospectivosRESUMEN
The following case report presents an unusual translunate, perilunate fracture-dislocation. To our knowledge, this occurrence has not been reported previously.
Asunto(s)
Fracturas Cerradas/patología , Traumatismos de la Muñeca/patología , Adulto , Hilos Ortopédicos , Fracturas Cerradas/diagnóstico por imagen , Fracturas Cerradas/cirugía , Humanos , Masculino , Radiografía , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/cirugíaRESUMEN
With increasing scrutiny of the role of women in the medical profession, there has been speculation that women physicians provide more sensitivity and empathy to their patients. To compare the psychosocial awareness of female and male physicians, medical records were reviewed for 909 patient visits to six women and seven men who were first year family practice residents. Charts were audited for evidence of acknowledgement of 21 categories of psychosocial or sexual problems. Women physicians saw more patients than their male counterparts and had a higher percentage of visits from women patients (73 percent compared to 65 percent): Types of medical problems seen were similar for men and women physicians with 42 percent of patients noted to have at least one psychosocial or sexual problem. Recognition of problems did not differ significantly between men and women physicians. Women physicians found 44 percent of their female patients had at least one psychosocial problem compared to a 40 percent rate for men physicians seeing either male or female patients, but this small difference could have occurred by chance. When three family medicine faculty members were asked to rank the residents, their ratings were better predictors of psychosocial awareness than was the sex of the resident physician.