RESUMEN
Metacarpophalangeal joint arthritis of the index finger is a debilitating disease often caused by osteoarthritis or inflammatory arthritides such as rheumatoid arthritis. Treatment options include nonsurgical management with nonsteroidal anti-inflammatory drugs, splinting, occupational therapy, corticosteroid injections, and disease-modifying antirheumatic drugs. Operative management options include arthrodesis and arthroplasty, which can be further broken down into silicone implants and 2 component resurfacing implants. The article summarizes the current literature for each of the treatment options for metacarpophalangeal joint arthritis of the index finger.
Asunto(s)
Articulación Metacarpofalángica , Humanos , Articulación Metacarpofalángica/cirugía , Férulas (Fijadores) , Artrodesis/métodos , Antirreumáticos/uso terapéutico , Osteoartritis/terapia , Osteoartritis/cirugía , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis/terapia , Artritis/etiología , Terapia Ocupacional/métodosRESUMEN
Fragility fractures as a result of osteoporosis, osteopenia, or vitamin D deficiency are some of the most common injuries encountered in orthopedics and require careful consideration when determining the appropriate management and treatment options. A thorough perioperative evaluation can identify causes of low bone mineral density allowing for initiation of appropriate therapy. Surgical treatment of these fractures can be difficult, and techniques should be employed to ensure stable fixation. It is important to understand the potential pitfalls associated with treatment of fragility fractures to prevent avoidable complications. Postoperative management is key to preventing future injuries in this unique patient population.
Asunto(s)
Enfermedades Óseas Metabólicas , Osteoporosis , Deficiencia de Vitamina D , Humanos , Deficiencia de Vitamina D/complicaciones , Enfermedades Óseas Metabólicas/etiología , Enfermedades Óseas Metabólicas/prevención & control , Osteoporosis/complicaciones , Extremidad Superior/cirugía , Extremidad Superior/lesiones , Fracturas Osteoporóticas/cirugía , Fracturas Osteoporóticas/prevención & control , Fracturas Osteoporóticas/etiología , Densidad ÓseaRESUMEN
Gout, or monosodium urate deposition disease, is the most common form of inflammatory arthritis that affects almost 4% of adults in the United States.Medical management involves lifestyle modifications and urate-lowering therapy to reduce the frequency of gout flares, decrease the tophi size, and improve upper extremity function. Goals for surgical management of gout include functional optimization, symptomatic treatment, and cosmetic restoration.This article focuses on the medical and surgical treatment of the common manifestations of gout in the upper extremity including tophi, tenosynovitis, joint contractures, neural compression, and arthropathy.
Asunto(s)
Gota , Hiperuricemia , Adulto , Humanos , Muñeca , Gota/terapia , Ácido Úrico , Extremidad SuperiorRESUMEN
The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.
Asunto(s)
Traumatismos de la Mano/cirugía , Procedimientos Ortopédicos/métodos , Traumatismos de la Muñeca/cirugía , Analgésicos Opioides/administración & dosificación , Evaluación de la Discapacidad , Humanos , Dolor Postoperatorio/tratamiento farmacológicoRESUMEN
The distal radial physis is a common site for injury in gymnasts because of the significant amount of load applied during upper extremity weight-bearing. Wrist pain has been reported in up to 88% of gymnasts. The long-term consequences of overuse wrist injuries, such as distal radial physeal arrest, include degenerative conditions that often cause pain and functional limitations. In the more immediate stage of many overuse injuries, early diagnosis can promote quicker care and recovery and thus faster return to play. Less time lost to injury can be very important in maintaining an athlete's quality of life.
Asunto(s)
Trastornos de Traumas Acumulados/etiología , Gimnasia/lesiones , Traumatismos de la Muñeca/etiología , Trastornos de Traumas Acumulados/diagnóstico por imagen , Trastornos de Traumas Acumulados/terapia , Humanos , Traumatismos de la Muñeca/diagnóstico por imagen , Traumatismos de la Muñeca/terapiaRESUMEN
Scaphoid fractures are common injuries in athletes. Most can be treated with cast immobilization, with an expected rate of union of 90% to 95%. Cast treatment, however, has the disadvantages of longer immobilization time, joint stiffness, reduced grip strength, and longer time to return to manual work or athletics. Closed reduction and percutaneous screw fixation generally are preferred in athletes to allow a quicker return to sport; if closed reduction cannot be obtained, open reduction and internal fixation may be required.
Asunto(s)
Traumatismos en Atletas/cirugía , Hueso Escafoides/lesiones , Artroscopía , Traumatismos en Atletas/diagnóstico , Humanos , Volver al DeporteRESUMEN
The distal interphalangeal (DIP) joints are subjected to the highest joint forces in the hand, and at least 60% of individuals older than age 60 years have DIP joint arthritis. Debridement of degenerative distal interphalangeal joints with mild to moderate disease can provide satisfactory outcomes; however, those joints with more severe angular and rotation changes are reliably treated with fusions. Regardless of the fixation method, DIP fusions have high success rates, are well tolerated, and are extremely durable.
Asunto(s)
Articulaciones de los Dedos/cirugía , Osteoartritis/cirugía , Pulgar/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Artrodesis , Humanos , Persona de Mediana Edad , Osteoartritis/epidemiología , Resultado del Tratamiento , Adulto JovenRESUMEN
Degenerative arthritis at the articulation of the scaphoid, trapezium, and trapezoid (STT or triscaphe joint) is a common degenerative disease of the wrist. Pain and weakness with grip strength reduction and functional limitations when performing routine daily tasks are common complaints of patients with STT arthritis. Initial conservative treatments for STT arthritis include splinting, bracing, activity modification, anti-inflammatory medication, and steroid injections for pain relief. Failure of conservative treatment is the main indication for surgery, which may include distal scaphoid excision, with or without filling of the void after excision, trapeziectomy, STT arthrodesis, or STT implant arthroplasty.
Asunto(s)
Articulaciones del Carpo/diagnóstico por imagen , Articulaciones del Carpo/cirugía , Osteoartritis/diagnóstico por imagen , Osteoartritis/cirugía , Anciano de 80 o más Años , Articulaciones del Carpo/patología , Manejo de la Enfermedad , Humanos , Hallazgos Incidentales , Procedimientos Ortopédicos , Osteoartritis/epidemiología , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/patología , Hueso Trapecio/diagnóstico por imagen , Hueso Trapezoide/diagnóstico por imagen , Hueso Trapezoide/patología , Resultado del TratamientoRESUMEN
The cost of carpal tunnel release (CTR) surgery can be decreased and patient satisfaction increased by a few relatively simple changes. Although cost estimates vary in the literature, most investigators agree that open CTR costs less than endoscopic CTR, and the clinic procedure room or ambulatory surgery center is cheaper than the ambulatory surgery center, which is less than the hospital. Patient satisfaction can be increased by making office visits more patient-centered and improving the quality of dialogue between the surgeon and patient.
Asunto(s)
Síndrome del Túnel Carpiano/cirugía , Costos de la Atención en Salud , Procedimientos Ortopédicos/economía , Evaluación de Resultado en la Atención de Salud/economía , Satisfacción del Paciente , Síndrome del Túnel Carpiano/economía , Humanos , Procedimientos Ortopédicos/normasRESUMEN
OBJECTIVES: To describe a midshaft forearm fracture pattern that places the ulnar nerve at risk in the pediatric population and provide 7 clinical case examples describing the injury pattern and treatment methods. DESIGN: Retrospective observational case series, review of literature, cadaver dissection, and treatment recommendations. SETTING: Multi-institutional, Southeast United States. PATIENTS: Seven pediatric patients (5 male and 2 female) with mean age of 8.7 years (range, 3-14) who sustained a significantly displaced closed, or grade I open, middle to distal one-third both-bone forearm fracture with subsequent ulnar nerve dysfunction. INTERVENTIONS: Manual reduction and casting of both-bone forearm shaft fractures, operative debridement, fracture fixation, nerve exploration, neurolysis, nerve repair, and nerve grafting. MAIN OUTCOME MEASUREMENTS: Radiographic fracture union, clinical ulnar nerve motor and sensory function testing, along with selective electric nerve testing and advanced imaging were monitored throughout follow-up postinjury. RESULTS: Five of 7 patients underwent surgical treatment and 2 others were treated with conservative measures. The ulnar nerve was entrapped within the fracture site of one patient with an open fracture along with partial nerve transection, and 4 patients were found to have the nerve encased in hypertrophic scar tissue or bony callus upon surgical exploration at 3-12 months postinjury. CONCLUSIONS: The ulnar nerve lies in a precarious position in the middle to distal one-third forearm and is bound by anatomic constraints that place the nerve at risk of injury. This article offers a treatment algorithm that includes conservative treatment, acute exploration, early exploration (≤3 months), and late exploration (>3 months). LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Reducción Abierta/métodos , Traumatismos de los Nervios Periféricos/etiología , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Nervio Cubital/lesiones , Adolescente , Adulto , Cadáver , Niño , Preescolar , Tratamiento Conservador/métodos , Disección , Femenino , Estudios de Seguimiento , Traumatismos del Antebrazo/complicaciones , Traumatismos del Antebrazo/cirugía , Curación de Fractura/fisiología , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Pediatría , Traumatismos de los Nervios Periféricos/fisiopatología , Traumatismos de los Nervios Periféricos/cirugía , Guías de Práctica Clínica como Asunto , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/rehabilitación , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/rehabilitaciónRESUMEN
Carpal tunnel syndrome (CTS) is one of the most common musculoskeletal disorders of the upper extremity. Comorbidities associated with the development of CTS include diabetes and obesity. Although a high rate of repetitive hand/wrist motions is a risk factor, there is insufficient evidence to implicate computer use in the development of CTS. Initial treatment generally is nonoperative, with the strongest evidence supporting bracing/splinting. Strong evidence supports operative treatment, regardless of technique, as superior to nonoperative treatment. Complications are infrequent and most are minor and transient.
Asunto(s)
Síndrome del Túnel Carpiano/rehabilitación , Síndrome del Túnel Carpiano/cirugía , Toma de Decisiones Clínicas/métodos , Descompresión Quirúrgica/métodos , Medicina Basada en la Evidencia , Factores de Edad , Anciano , Síndrome del Túnel Carpiano/diagnóstico por imagen , Síndrome del Túnel Carpiano/epidemiología , Tratamiento Conservador/métodos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Férulas (Fijadores) , Resultado del TratamientoRESUMEN
WALANT (wide-awake local anesthesia no tourniquet) appears to be a safe and effective anesthesia technique for many hand and wrist surgeries. Patient satisfaction is high because of the avoidance of preoperative testing and hospital admission. Postoperative recovery is rapid, and procedures can be done in outpatient settings, resulting in substantial savings in time and money.
Asunto(s)
Anestesia Local , Mano/cirugía , Procedimientos Ortopédicos , Protocolos Clínicos , Humanos , TorniquetesRESUMEN
Outpatient surgery, especially in free-standing ambulatory surgery centers (ASC), provides a safe, cost-effective option for a variety of surgical procedures and has become the preferred choice over inpatient and hospital-based outpatient surgery for most hand and wrist procedures. Complication rates after ASC hand surgery are low (0.2%-2.5%). Patient dissatisfaction with ASC surgery is primarily associated with postoperative nausea and vomiting and inadequate pain control.
Asunto(s)
Instituciones de Atención Ambulatoria , Procedimientos Quirúrgicos Ambulatorios , Mano/cirugía , Procedimientos Ortopédicos , HumanosRESUMEN
Orthobiologics are not used as frequently in the hand and wrist as in other sites. The most frequently reported is the use of bone morphogenetic protein for the treatment of Kienböck disease. Animal studies have described improved tendon healing with the use of platelet-rich plasma (PRP), but no clinical studies have confirmed these results. PRP has been reported to produce improvements in the outcomes of distal radial fractures and osteoarthritis of the trapeziometacarpal in small numbers of patients. The use of orthobiologics in the hand and wrist are promising, but clinical trials are necessary to establish efficacy and safety.
Asunto(s)
Terapia Biológica , Proteínas Morfogenéticas Óseas/farmacología , Curación de Fractura/fisiología , Traumatismos de la Mano , Plasma Rico en Plaquetas , Traumatismos de la Muñeca , Terapia Biológica/instrumentación , Terapia Biológica/métodos , Traumatismos de la Mano/fisiopatología , Traumatismos de la Mano/terapia , Humanos , Ortopedia/métodos , Traumatismos de la Muñeca/fisiopatología , Traumatismos de la Muñeca/terapiaRESUMEN
Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy). Autologous blood injections and platelet-rich plasma injections are the two most frequently used orthobiologic techniques in the treatment of lateral epicondylitis. Studies of the effectiveness of autologous blood injections and platelet-rich plasma report varying outcomes, some citing significant clinical relief and others reporting no beneficial effect. More research is needed to determine how to best use orthobiologics in the treatment of lateral epicondylitis.
Asunto(s)
Tratamiento Conservador/métodos , Plasma Rico en Plaquetas , Codo de Tenista , Humanos , Inyecciones , Codo de Tenista/diagnóstico , Codo de Tenista/fisiopatología , Codo de Tenista/terapia , Resultado del TratamientoRESUMEN
The olecranon process, coronoid process, and greater sigmoid notch are important components of the complex proximal ulna. Along with providing bony stability to the ulnohumeral joint, the proximal ulna serves as the attachment site of many important muscles and ligaments that impart soft tissue stability to the elbow joint. Management of proximal ulnar fractures continues to evolve as advances in imaging and anatomic and biomechanical studies have led to improvements in available implants; however, controversies remain, as shown in the current relevant literature.
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Fijación Interna de Fracturas/métodos , Olécranon/lesiones , Fracturas del Cúbito/cirugía , Humanos , Olécranon/cirugíaRESUMEN
Volar plate fixation of unstable distal radius fractures has become the preferred technique by most surgeons for the operative treatment of displaced distal radius fractures. Flexor tendon rupture is a rare but serious complication associated with this operation that is thought to be due to irritation of the flexor tendons over the prominent distal edge of the plate. We describe a novel technique of using the brachioradialis tendon to cover the distal edge of the plate to help prevent tendon irritation and rupture.
Asunto(s)
Placas Óseas , Fijación Interna de Fracturas/métodos , Placa Palmar/cirugía , Fracturas del Radio/cirugía , Traumatismos de los Tendones/prevención & control , Tendones/cirugía , Fijación Interna de Fracturas/efectos adversos , Humanos , Selección de Paciente , Rotura , Traumatismos de los Tendones/etiologíaRESUMEN
Hand injuries account for up to 15% of sports injuries and are common in contact sports and in sports with a high risk of falling. Appropriate management requires knowledge of the type of injury, demands of the sport and position, competitive level of the athlete, future athletic demands and expectations, and the role of rehabilitation and protective splints for return to play. Management of the athlete requires aggressive and expedient diagnostic intervention and treatment. This article describes ligamentous injuries to the thumb, including thumb carpometacarpal dislocations, thumb metacarpophalangeal dislocations, collateral ligament injuries and interphalangeal dislocations, their evaluation, treatment and outcomes.
Asunto(s)
Atletas , Traumatismos en Atletas/epidemiología , Ligamentos Colaterales/lesiones , Traumatismos de la Mano/epidemiología , Articulación Metacarpofalángica/lesiones , Pulgar/lesiones , Humanos , Incidencia , Estados Unidos/epidemiologíaAsunto(s)
Mano/cirugía , Ortopedia/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados UnidosRESUMEN
This study compares results of endoscopic carpal tunnel release using the two-portal technique in two groups of patients based on whether or not they were receiving workers' compensation. There were 50 patients in the worker's compensation group and 63 in the nonworker's compensation group. Mean follow-up was 40.8 months and 44.8 months, respectively. Duration of symptoms before surgery was statistically different in the two groups, 13.6 months in the worker's compensation groups compared to 26.2 months in the nonworker's compensation group. Worker's compensation patients tended to be younger, have shorter duration of symptoms before surgery, report lower postoperative activity levels, have more subsequent surgeries, and have mediocre results when compared to nonworker's compensation patients. There was no statistically significant difference in the rate or timing of return to work. Our series of 113 patients who had endoscopic carpal tunnel release indicates that careful patient selection is necessary to achieve satisfactory outcomes in worker's compensation patients.