RESUMEN
The purpose of this study was to measure the functional range of motion of the finger joints needed to perform activities of daily living. Using the Sollerman hand grip function test, 20 activities were assessed in ten volunteers. The active and passive range of motion was measured with a computerized electric goniometer. The position of each finger joint was evaluated in the pre-grasp and grasp positions. The functional range of motion was defined as the range required to perform 90% of the activities, utilizing the pre-grasp and grasp measurements. The functional range of motion was 19°-71°, 23°-87°, and 10°-64° at the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively. This represents 48%, 59%, and 60% of the active motion of these joints, respectively. There was a significant difference in the functional range of motion between the joints of the fingers, with the ulnar digits having greater active and functional range. The functional range of motion is important for directing indications for surgery and rehabilitation, and assessing outcome of treatment.
Asunto(s)
Actividades Cotidianas , Articulaciones de los Dedos/fisiología , Fuerza de la Mano/fisiología , Articulación Metacarpofalángica/fisiología , Rango del Movimiento Articular/fisiología , Adolescente , Adulto , Artrometría Articular , Femenino , Voluntarios Sanos , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
PURPOSE: Interscalene brachial plexus (ISBP) block has been shown to be safe and effective for shoulder surgery with significant benefits. The purpose of this study was to introduce the technique of digitally assisted acromioplasty and assess the effect of ISBP on rehabilitation. TYPE OF STUDY: Randomized controlled prospective trial. METHODS: In a randomized prospective trial of 40 patients undergoing acromioplasty under general anesthesia, 20 patients received an ISBP block (group 1) and 20 had no block (group 2). A digitally assisted acromioplasty was performed using a burr introduced via a posterior portal. The undersurface of the acromion was debrided, directing the burr with the surgeon's index finger introduced via a small lateral incision. Independent review was at day 1, day 2, week 1, week 6, and 1 year. RESULTS: Group 1 had significantly greater shoulder motion and shoulder score, and less pain and analgesic requirements on the first day. These differences did not persist. Both groups had improved pain and function over time compared with preoperative scores. CONCLUSIONS: ISBP provides superior initial results but does not offer any significant persistent functional or rehabilitative advantage in the medium to long term. Digitally assisted acromioplasty is simple to perform and does not violate the deltoid insertion.
Asunto(s)
Articulación Acromioclavicular/cirugía , Acromion/cirugía , Bloqueo Nervioso Autónomo/métodos , Hombro/cirugía , Terapia Asistida por Computador , Actividades Cotidianas , Administración Oral , Adulto , Bupivacaína/administración & dosificación , Desbridamiento , Femenino , Fentanilo/administración & dosificación , Humanos , Inyecciones Intravenosas , Masculino , Midazolam/administración & dosificación , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Satisfacción del Paciente , Medicación Preanestésica , Propofol/administración & dosificación , Estudios Prospectivos , Rango del Movimiento Articular , Hombro/fisiopatología , Lesiones del Hombro , Temazepam/administración & dosificaciónRESUMEN
The authors describe a technique with a single anterior incision and fixation with an internal button, the Endobutton. The procedure is performed through a 5-cm transverse skin incision, and the tendon is sutured to the Endobutton with 2 number 5 Ethibond sutures. Surgical repair in the depths of the muscular forearm is not required, because the tendon is simply sutured external to the wound. The Endobutton delivers and locks the tendon into a hole in the radial tuberosity. The Endobutton technique was used in 12 patients who were allowed early active mobilization. All were satisfied, returned to activities, and regained grade 5 strength. Average flexion was from 5 degrees to 146 degrees with 81 degrees supination and 80 degrees pronation. No neurovascular complications or synostosis occurred. In cadaveric studies the average distance from the biceps tendon were ulnar artery 6 mm, median nerve 12 mm, and posterior interosseous nerve 18 mm. The average distance from the posterior interosseous nerve to a Steinman pin advanced through the proximal radius was 14 mm. This technique is a safe and effective method of repair of distal biceps tendon avulsion that allows active mobilization with minimal risk of complication.
Asunto(s)
Traumatismos del Brazo/cirugía , Dispositivos de Fijación Ortopédica , Procedimientos Ortopédicos/instrumentación , Traumatismos de los Tendones/cirugía , Adulto , Cadáver , Disección , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/lesiones , Procedimientos Ortopédicos/métodos , Rotura/cirugía , Sensibilidad y Especificidad , Técnicas de Sutura , Resultado del TratamientoRESUMEN
We treated 31 intra-articular fractures of the distal radius by arthroscopically-assisted reduction and percutaneous fixation with Kirschner (K-) wires. Tears of the triangular fibrocartilage (58 %), scapholunate (85 %) and lunotriquetral (61%) instability and osteochondral lesions (19%) were also treated. A total of 26 patients was independently reviewed at an average of 19 months. The mean pain score was 1.3/10, the range of movement 79% and the grip strength 90% of the contralateral wrist. Using the New York Orthopaedic Hospital score, 88% were graded excellent to good. On follow-up radiographs, 65% had no step and 31% had a step of < or =1 mm. Pain was significantly related to the size of the step. There was a significant difference in the incidence of persistent scapholunate diastasis and the Leibovic and Geissler grade (p < 0.01): I (0%), II (0%), III (42%) and IV (100%). We recommend anatomical reduction and acceptance of a step of <1 mm since the size of the step is related to the incidence of pain.
Asunto(s)
Artroscopía , Hilos Ortopédicos , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios , Complicaciones Posoperatorias/epidemiología , Cuidados Preoperatorios , Radiografía , Fracturas del Radio/diagnóstico por imagen , Traumatismos de la Muñeca/diagnóstico por imagenRESUMEN
Pain, stiffness, instability and degenerative arthritis are common sequelae of complex fracture-dislocations of the proximal interphalangeal (PIP) joint. Operations were carried out to obtain stability, followed by application of a dynamic external fixator in 20 patients with a mean age of 29 years. This provided stability and distraction, and allowed controlled passive movement. Most (70%) of the patients had a chronic lesion and the mean time from injury to surgery was 215 days (3 to 1953). The final mean range of movement was 12 to 86 degrees. Complications included redislocation and septic arthritis, which affected the outcome. Four pin-track infections and two breakages of the hinge did not influence the result. The PIP Compass hinge is a useful adjunct to surgical reconstruction of the injured PIP joint.
Asunto(s)
Fijadores Externos , Traumatismos de los Dedos/cirugía , Adolescente , Adulto , Artroplastia , Femenino , Fijación Interna de Fracturas , Fracturas Óseas/cirugía , Humanos , Luxaciones Articulares/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Rango del Movimiento ArticularRESUMEN
Elevation of the upper extremity after elbow surgery has rarely been advocated and can be difficult to achieve. Usually the extremity is elevated with the elbow at 90 degrees of flexion, so that swelling from the hand drains to the elbow but the elbow remains dependent. Excessive swelling causes discomfort and compromised wound healing, makes early mobilization difficult, and predisposes to joint contracture. We report on a dynamic elbow suspension splint, which is analogous to the Thomas splint used for femoral shaft fractures. The arm is held in full extension with an above-elbow plaster slab and is secured to the Thomas splint with skin traction. The splint is suspended on a Balkan frame at an angle of 60 degrees. We prefer to use the new Zimmer Thomas splint, because it is radiolucent and has self-adhesive sheep-skin supports that can be simply applied. It allows the patient to mobilize in bed and is well tolerated by patients and nursing staff. The dynamic elbow suspension splint is a useful adjunct after complex elbow surgery or trauma, because it reduces swelling and maintains the elbow in extension.