RESUMEN
A free temporoparietal fascial flap with a split-thickness skin graft was used to cover a large palmar forearm wound in a patient whose hand had been replanted 21 days earlier after traumatic amputation at the distal forearm level. At a 39-month follow-up, the patient had achieved an excellent cosmetic and functional result, with no alopecia or facial nerve injury. The flap is advantageous for coverage of wounds that require a large amount of thin, pliable tissue, and it leaves a concealed donor-site scar.
Asunto(s)
Amputación Traumática/cirugía , Traumatismos del Antebrazo/etiología , Traumatismos del Antebrazo/cirugía , Microcirugia/métodos , Reimplantación/efectos adversos , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Accidentes de Trabajo , Adulto , Terapia Combinada , Fascia/trasplante , Mano/cirugía , Humanos , Masculino , Hueso Parietal , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Hueso Temporal , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Severely comminuted AO type-C3 intra-articular fractures of the distal end of the radius are difficult to treat. Failure to achieve and maintain nearly anatomic restoration can result in pain, instability, and poor function. We report the results of a retrospective study of the use of a standard protocol of open reduction and combined internal and external fixation of these fractures. METHODS: Seventeen of twenty-five patients treated with the protocol were available for follow-up evaluation. Six had an AO type-C3.1 fracture; eight, type-C3.2; and three, type-C3.3. Eleven fractures required a dorsal buttress plate and/or a volar buttress plate, and eleven required bone-grafting. The mean time until the external fixator was removed was seven weeks. RESULTS: At a mean of thirty months postoperatively, the mean arc of flexion-extension was 72% of that on the uninjured side and the mean grip strength was 73% of that on the uninjured side. The mean articular step-off was 1 mm, the total articular incongruity (the gap plus the step-off) averaged 2 mm, and the radial length was restored to a mean of 11 mm. Thirteen patients had less than 3 mm of total articular incongruity. Arthritis was graded as none in three patients, mild in ten, moderate in three, and severe in one. According to the Gartland and Werley demerit-point system, ten of the patients had a good or excellent result. According to the modified Green and O'Brien clinical rating system, five had a good or excellent result. One patient had a fracture collapse requiring wrist fusion, one had reflex sympathetic dystrophy, and three had minor Kirschner-wire-related problems. Total articular incongruity immediately postoperatively had a moderately strong correlation with the outcome as assessed with both clinical rating systems (r = 0.70 and 0.74 for the Gartland and Werley system and the Green and O'Brien system, respectively; p<0.05). CONCLUSIONS: Open reduction and combined internal and external fixation of AO type-C3 fractures can restore radiographic parameters to nearly normal values, maintain reduction throughout the period of fracture-healing, and provide satisfactory functional results.
Asunto(s)
Fijación Interna de Fracturas , Fijación de Fractura , Fracturas Conminutas/cirugía , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Adulto , Fijadores Externos , Femenino , Estudios de Seguimiento , Fracturas Conminutas/diagnóstico por imagen , Humanos , Masculino , Satisfacción del Paciente , Radiografía , Fracturas del Radio/diagnóstico por imagen , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Traumatismos de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugíaRESUMEN
Six patients with severe hand and forearm injuries involving open wounds and exposed structures were treated with reverse radial forearm fascial flaps and split-thickness skin grafts for soft tissue cover. There were five men and one woman aged between 16 and 36 years. Injuries included soft tissue avulsion on the dorsum of the hand and fingers, extensive flexor and extensor tendon damage, multiple phalangeal fractures, a grade IIIB open dislocation of the index to little carpometacarpal joints, a grade III open metacarpal fracture and a finger amputation. The average wound size was 9 cm in length and 7 cm in width. The mean duration of follow-up was 12 months (range, 5-20 months). All flaps healed well, and all patients were satisfied.
Asunto(s)
Traumatismos del Antebrazo/cirugía , Traumatismos de la Mano/cirugía , Colgajos Quirúrgicos , Adulto , Desbridamiento , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas , Humanos , Masculino , Estudios Retrospectivos , Trasplante de Piel , Factores de Tiempo , Infección de Heridas/cirugíaRESUMEN
The most definitive method for confirming the diagnosis of synovial chondromatosis is the identification of cartilaginous metaplasia within the synovium on histologic examination. In advanced stages of the disease, plain radiographs and magnetic resonance imaging (MRI) scans demonstrate calcified and cartilaginous bodies, respectively, but in earlier stages, plain radiographic findings may be normal and MRI scans may reveal only nonspecific increased fluid. Although rare in the wrist, synovial chondromatosis must be considered in the differential diagnosis in a patient presenting with pain and swelling of the distal radioulnar joint. Surgical exploration of the joint and synovectomy, alone or in combination with removal of loose bodies, is the recommended treatment.
Asunto(s)
Condromatosis Sinovial/diagnóstico , Articulación de la Muñeca , Adulto , Condromatosis Sinovial/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Radio (Anatomía) , Cúbito , Articulación de la Muñeca/patologíaAsunto(s)
Enfermedades de los Perros , Factor I del Crecimiento Similar a la Insulina/uso terapéutico , Metaloendopeptidasas/análisis , Osteoartritis/veterinaria , Poliéster Pentosan Sulfúrico/uso terapéutico , Animales , Ligamento Cruzado Anterior/cirugía , Colagenasas/análisis , Perros , Glicoproteínas/análisis , Osteoartritis/metabolismo , Osteoartritis/terapia , Inhibidores Tisulares de MetaloproteinasasRESUMEN
The potential therapeutic effects of insulin-like growth factor-1 (IGF-1) and sodium pentosan polysulfate (PPS) were evaluated in an anterior cruciate ligament-deficient canine model of osteoarthritis (OA). A control group of animals received no treatment or surgery (N). The remaining four groups of animals received anterior cruciate transection and either no treatment (OA), intra-articular IGF-1 (IGF-1), intra-muscular PPS (PPS), or a combination of intra-articular IGF-1 and intra-muscular PPS (IGF-1/PPS). All therapy was begun 3 weeks after surgery and continued for 3 weeks. At 6 weeks, articular cartilage from the femoral condyle was evaluated for anatomy, histology (Mankin grade) and biochemistry. Anatomically, only cartilage from dogs in the IGF-1/PPS group approximated that found in N. Mankin scores indicated less severe disease in both PPS and IGF-1/PPS groups compared with the OA group. Consistent with histology, the level of active neutral metalloproteinase was lower in cartilage from the PPS group compared with the OA group. Active and total neutral metalloproteinase, tissue inhibitor of metalloproteinases (TIMP), total collagenase, uronate and hydroxyproline contents were all near normal in the IGF-1/PPS group. In a model of mild OA, therapeutic intervention with IGF-1 and PPS appeared to successfully maintain cartilage structure and biochemistry. From these data, it is hypothesized that proteinase activity was successfully blocked by PPS, and that this allowed the observed growth factor induced effects. As we unravel the various factors that regulate cartilage metabolism, it is becoming apparent that combinations of agents will be needed to effectively control cartilage repair in OA. The addition of PPS to IGF-1 shows promise as a therapeutic intervention and introduces a new rational approach to therapy of OA.