RESUMEN
CASE: A 31-year-old Caucasian man presented with a greater arc perilunate variant injury after falling from a friend's shoulders onto an outstretched hand. Imaging revealed a minimally displaced scaphoid waist fracture and a nondisplaced transverse fracture through a previously unrecognized lunotriquetral coalition. A volar intercalated segmental instability (VISI) deformity was present. Open reduction with osseous fixation (a headless compression screw for the scaphoid waist fracture and 3 Kirschner wires across the midcarpal joint) and repair of the torn volar ligaments partially restored the carpal alignment. At 1 year postoperatively, the patient had regained approximately 90% of grip and pinch strength, 70% of wrist flexion, and 80% of wrist extension when compared with the contralateral, uninjured side. Despite persistent VISI alignment, he was satisfied with the outcome and had returned to his preoperative employment and recreational activities. CONCLUSION: A high index of suspicion for a perilunate injury should be maintained for all scaphoid fractures, particularly when abnormal anatomy is present.
Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Reducción Abierta/métodos , Traumatismos de la Muñeca/cirugía , Adulto , Fijación Interna de Fracturas/instrumentación , Fracturas Óseas/diagnóstico por imagen , Humanos , Masculino , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Needle aponeurotomy is an effective, minimally invasive treatment for metacarpophalangeal and interphalangeal joint contractures caused by Dupuytren disease. Multiple joints and digits can be safely treated in 1 session. Needle aponeurotomy is more cost-effective and has a significantly lower complication rate compared with open fasciectomy and collagenase injections. Recurrence rates are higher compared with open fasciectomy and collagenase injections. Patient satisfaction rates are high following needle aponeurotomy; the single clinic visit required and the minimal downtime after treatment are advantages unique to this procedure compared with other treatment modalities, including open fasciectomy, dermatofasciectomy, collagenase injections, and lipofilling.
Asunto(s)
Procedimientos Quirúrgicos Ambulatorios , Aponeurosis/cirugía , Contractura de Dupuytren/cirugía , Agujas , Procedimientos Ortopédicos/métodos , Tejido Adiposo/trasplante , Anestésicos Locales/administración & dosificación , Contraindicaciones de los Procedimientos , Contractura de Dupuytren/clasificación , Fibroma/cirugía , Glucocorticoides/uso terapéutico , Humanos , Inyecciones Intralesiones , Procedimientos Quirúrgicos Mínimamente Invasivos , Procedimientos Ortopédicos/instrumentación , Satisfacción del Paciente , Cuidados Posoperatorios , Complicaciones Posoperatorias , Cuidados Preoperatorios , Años de Vida Ajustados por Calidad de Vida , Recurrencia , Triamcinolona/uso terapéutico , Ultrasonografía IntervencionalRESUMEN
BACKGROUND: Scapholunate ligament injuries are highly challenging injuries to treat. Great uncertainly remains in determining which operative procedures are most effective. Furthermore, there is no consensus on whether surgical intervention changes the natural course of scapholunate injuries. METHODS: The authors present their assessment of scapholunate injuries and the senior author's preferred surgical techniques. Surgical videos are included. The authors' postoperative management is described. RESULTS: Operative procedures are selected based on the patient's timing and pattern of injury, degree of associated carpal changes and arthritis, and goals. CONCLUSION: Over the past 20 years, the senior author has had good success with these techniques, but prospective, longterm outcome studies are needed to critically assess whether these surgical techniques improve patients' long-term function and pain.
Asunto(s)
Artralgia/cirugía , Artroplastia/métodos , Artroscopía/métodos , Articulaciones del Carpo/cirugía , Ligamentos Articulares/cirugía , Artralgia/etiología , Articulaciones del Carpo/diagnóstico por imagen , Articulaciones del Carpo/lesiones , Articulaciones del Carpo/inervación , Desnervación/métodos , Humanos , Ligamentos Articulares/diagnóstico por imagen , Ligamentos Articulares/lesiones , Hueso Semilunar/diagnóstico por imagen , Hueso Semilunar/cirugía , Estudios Prospectivos , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/cirugía , Tenodesis/métodos , Resultado del TratamientoRESUMEN
Football and rugby athletes are at increased risk of finger injuries given the full-contact nature of these sports. Some players may return to play early with protective taping, splinting, and casting. Others require a longer rehabilitation period and prolonged time away from the field. The treating hand surgeon must weigh the benefits of early return to play for the current season and future playing career against the risks of reinjury and long-term morbidity, including post-traumatic arthritis and decreased range of motion and strength. Each player must be comprehensively assessed and managed with an individualized treatment plan.
Asunto(s)
Traumatismos de los Dedos/terapia , Fútbol Americano/lesiones , Traumatismos de los Dedos/etiología , Predicción , Humanos , Volver al DeporteRESUMEN
BACKGROUND: The provision of study results to research participants is supported by pediatric and adult literature. This study assessed adult cancer patient preferences surrounding aggregate result disclosure to study participants. METHODS: A 46-item questionnaire was given to 250 adult cancer patients who had participated in oncology trials at a single center. Respondents answered questions surrounding their preferences for timing, content, and modality of communication for dissemination of study results. RESULTS: Questionnaire completion rate was 76% (189/250). Most patients (92%) strongly felt a right to know study results. Patients preferred result dissemination via letter for trials with positive outcomes, but preferred in-person clinic visits for negative outcomes. Despite this, a majority of participants (59%) found letters acceptable to inform participants of negative results. Only a minority (36%) of the participants found Internet-based disclosure acceptable for negative trial results. Unfortunately, very few patients (8%) recalled having received the results for a study they participated in, and of these patients, less than half fully understood the results they were given. CONCLUSION: Most clinical trial participants feel they have a right to study result disclosure, regardless of trial outcome. In-person visits are preferred for negative results, but more feasible alternatives such as letters were still acceptable for the majority of participants. However, Internet-based disclosure was not acceptable to most participants in oncology trials. Time and cost allocations for result disclosure should be considered during grant and ethics board applications, and clear guidelines are required to help researchers share the results with patients.
Asunto(s)
Actitud Frente a la Salud , Ensayos Clínicos como Asunto , Comunicación , Revelación , Neoplasias/terapia , Sujetos de Investigación , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Difusión de la Información , Internet , Masculino , Persona de Mediana Edad , Relaciones Profesional-Paciente , Investigadores , Encuestas y CuestionariosRESUMEN
Reconstruction of the suprascapular nerve (SSN) after brachial plexus injury often involves nerve grafting or a nerve transfer. To restore shoulder abduction and external rotation, a branch of the spinal accessory nerve is commonly transferred to the SSN. To allow reinnervation of the SSN, any potential compression points should be released to prevent a possible double crush syndrome. For that reason, the authors perform a release of the superior transverse scapular ligament at the suprascapular notch in all patients undergoing reconstruction of the upper trunk of the brachial plexus. Performing the release through a standard anterior open supraclavicular approach to the brachial plexus avoids the need for an additional posterior incision or arthroscopic procedure.