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Aims: Complete ruptures of the ulnar collateral ligament (UCL) of the thumb are a common injury, yet little is known about their current management in the UK. The objective of this study was to assess the way complete UCL ruptures are managed in the UK. Methods: We carried out a multicentre, survey-based cross-sectional study in 37 UK centres over a 16-month period from June 2022 to September 2023. The survey results were analyzed descriptively. Results: A total of 37 centres participated, of which nine were tertiary referral hand centres and 28 were district general hospitals. There was a total of 112 respondents (69 surgeons and 43 hand therapists). The strongest influence on the decision to offer surgery was the lack of a firm 'endpoint' to stressing the metacarpophalangeal joint (MCPJ) in either full extension or with the MCPJ in 30° of flexion. There was variability in whether additional imaging was used in managing acute UCL injuries, with 46% routinely using additional imaging while 54% did not. The use of a bone anchor was by far the most common surgical option for reconstructing an acute ligament avulsion (97%, n = 67) with a transosseous suture used by 3% (n = 2). The most common duration of immobilization for those managed conservatively was six weeks (58%, n = 65) and four weeks (30%, n = 34). Most surgeons (87%, n = 60) and hand therapists (95%, n = 41) would consider randomizing patients with complete UCL ruptures in a future clinical trial. Conclusion: The management of complete UCL ruptures in the UK is highly variable in certain areas, and there is a willingness for clinical trials on this subject.
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Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.
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Trastornos de Traumas Acumulados , Muñeca , Adolescente , Humanos , Ansiedad , ArtralgiaRESUMEN
Cutibacterium (Propionibacterium) acnes (C. acnes, previously known as P. acnes) is an anaerobic organism that commonly colonizes the human skin. After Staphylococcus spp. and Streptococcus spp., it is a common organism associated with deep prosthetic shoulder joint infections. We describe the case of rapidly progressive arthropathy of the native wrist secondary to infection with C. acnes. Diagnosis was made on prolonged enrichment cultures. The patient went on to complete a long-term course of oral sulfamethoxazole-trimethoprim with clinical improvement. To the best of our knowledge, this is the first report in the literature that C. acnes has been the main causative organism implicated in infection of the native wrist joint. It is imperative to request and wait for results of prolonged enrichment cultures to aid microbiological diagnosis in such cases.
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Artritis Infecciosa , Articulación del Hombro , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Humanos , Propionibacterium acnes , Hombro , Muñeca , Articulación de la MuñecaRESUMEN
Relapsing-remitting sixth nerve palsy is usually due to ophthalmoplegic migraine (recurrent cranial nerve palsy) in younger patients and microvascular disease in older patients. There have been isolated reports, however, of it occurring in the presence of a skull base tumour. We report a 20-year-old woman with Ollier's disease who presented with a relapsing-remitting sixth nerve palsy. Neuro-imaging revealed a skull base enchondroma.
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UNLABELLED: consequently reports in the international literature are mainly of individual cases and small series. MATERIAL OF STUDY: This is a retrospective review of a series of 25 patients with lipomatous tumours of the hand and wrist treated between 2001 and 2009. All patients underwent clinical and radiological assessment and a marginal excisional biopsy. 23 lipomas, 1 fibrolipomatous hamartoma (FLH) and 1 well differentiated lipoma-like liposarcoma/atypical lipomatous tumour (WDLLL/ALT) were identified. CONCLUSION: Choosing the most appropriate investigations is mandatory for a correct diagnosis and planning. Ultrasound should always be considered as the first line investigation. MRI helps delineating the anatomy of the lesions and their relationships with the surrounding structures in the hand and wrist, enabling more accurate surgical planning. Histological examination of the excised specimen remains the gold standard for the formulation of the definitive diagnosis and should be performed in every case. KEY WORDS: Digits tumours, Fibrolipomatous hamartoma, Hand tumours, Lipoma, Lipoma-like liposarcoma, Wrist tumours.
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Hamartoma/diagnóstico , Lipoma/diagnóstico , Liposarcoma/diagnóstico , Neoplasias Cutáneas/diagnóstico , Biopsia , Diagnóstico Diferencial , Hamartoma/cirugía , Mano/patología , Humanos , Lipoma/cirugía , Liposarcoma/cirugía , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Neoplasias Cutáneas/cirugía , Resultado del Tratamiento , Ultrasonografía/métodos , Muñeca/patologíaAsunto(s)
Inmovilización/métodos , Dolor/etiología , Cinta Quirúrgica/efectos adversos , Pulgar/lesiones , Adulto , Preescolar , Femenino , Fracturas Óseas/terapia , Humanos , Inmovilización/efectos adversos , Londres , Masculino , Articulación Metacarpofalángica/lesiones , Traumatismos de los Tejidos Blandos/terapia , Férulas (Fijadores)Asunto(s)
Lesiones de Codo , Luxaciones Articulares/cirugía , Hueso Semilunar/lesiones , Adulto , Diagnóstico Diferencial , Articulación del Codo/patología , Articulación del Codo/cirugía , Humanos , Hueso Semilunar/diagnóstico por imagen , Hueso Semilunar/cirugía , Masculino , Procedimientos Ortopédicos/métodos , RadiografíaRESUMEN
The purpose of this study was to describe and evaluate a new technique for ultrasound-guided percutaneous release of the annular pulley in trigger digit using a modified hypodermic needle. A total of 35 ultrasound-guided percutaneous releases were performed on 25 patients diagnosed and referred by hand surgeons in our institution over 16 months from October 2006. Inclusion criteria were as follows: adulthood, triggering present for at least 4 months, failure to respond to conservative management or steroid injections, no previous history of pulley release in the affected digit. Under ultrasound guidance, the affected pulley was released using a standard 19-gauge hypodermic needle bent at two points as the cutting device. Follow-up took place at 12 weeks and 6 months with improvement in triggering and clinically graded pain. At follow-up, no complications had occurred and all patients demonstrated improvement in their triggering, with complete resolution in 32 digits (91%), good improvement in 2 digits (6%) and some improvement in 1 digit (3%). This new technique uses a widely available and safe cutting device and is safe and can be used to provide definitive management for trigger finger, allowing the procedure to be performed in a variety of clinical settings.
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Procedimientos de Cirugía Plástica/métodos , Cirugía Asistida por Computador/métodos , Tendones/cirugía , Trastorno del Dedo en Gatillo/diagnóstico por imagen , Trastorno del Dedo en Gatillo/cirugía , Ultrasonografía Intervencional/métodos , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
Holes are frequently drilled across small bones to achieve fixation with intraosseous wires. We describe an effective, simple and cheap alternative to the use of K-wires for this purpose in this article.