Asunto(s)
Traumatismos de los Dedos/cirugía , Luxaciones Articulares/cirugía , Articulación Metacarpofalángica/lesiones , Procedimientos Ortopédicos/métodos , Preescolar , Femenino , Traumatismos de los Dedos/diagnóstico , Humanos , Luxaciones Articulares/diagnóstico , Articulación Metacarpofalángica/cirugíaRESUMEN
OBJECTIVE: To develop a clinical decision guide for the diagnosis and treatment of hyperextension injuries of long fingers. STUDY DESIGN: Consecutive patients age <16 years (n = 300) with an acute proximal interphalangeal (PIP) joint hyperextension injury were included. High-risk and low-risk measures for severe injury were established with a standardized clinical examination and anteroposterior and lateral radiographs of the injured finger. Four clinical variables were assessed: location of pain; swelling and bruising, stability, and mobility. Pathological radiographic findings were compiled, and the risk of late complications was analyzed. The predictive value of the clinical examination in the identification of low-risk injuries was assessed. RESULTS: The majority (67%) of children consulting for a hyperextension finger trauma did not have a fracture. No child with a low-risk clinical examination had a subsequent high-risk diagnosis (eg, relevant intra-articular fracture, dislocation). Among 64 clinical high-risk diagnoses only 12 significant fractures were found. CONCLUSION: Treatment decisions after PIP hyperextension injuries can be based on a clinical examination using a standardized evaluation protocol. Application of the clinical decision guide presented here has a sensitivity of 100% to rule out a significant injury. Present results showed that the majority of radiographs currently performed are avoidable. Once the decision rule is validated, its clinical application will improve patient care, reduce waiting times in emergency departments, avoid unnecessary radiation exposure, and possibly reduce costs.
Asunto(s)
Toma de Decisiones Clínicas , Técnicas de Apoyo para la Decisión , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/terapia , Adolescente , Niño , Humanos , Estudios ProspectivosRESUMEN
Cutaneous abscess is a localized collection of pus in the dermis and subcutaneous tissue usually caused by trauma. The authors report the case of a 30-year-old male patient, gardener, that presents an ulcerated plaque in the third right finger, caused by an aculeus plant wound. The examination of the lesion's exudate ruled out the existence of fungi and showed the presence of Staphylococcus aureus. The authors emphasize the sporotrichosis as an important differential diagnosis, especially in endemic areas, and the indication of the exudate culture is discussed.
Abscesso cutâneo é uma coleção de pus localizada na derme e tecido celular subcutâneo decorrente, em geral, de traumatismos. Os autores relatam o caso de um paciente de 30 anos, jardineiro, apresentando uma placa ulcerada, no terceiro quirodáctilo direito, provocada por ferimento com acúleo de planta. O exame do exsudato da lesão descartou a presença de fungos e revelou a presença de Staphylococcus aureus. Os autores enfatizam a importância de se lembrar da esporotricose no diagnóstico diferencial, principalmente em regiões endêmicas e discutem a indicação da cultura do exsudato no caso apresentado.
Asunto(s)
Adulto , Humanos , Masculino , Absceso/diagnóstico , Rosaceae , Piel/lesiones , Infecciones Cutáneas Estafilocócicas/diagnóstico , Absceso/microbiología , Diagnóstico Diferencial , Exudados y Transudados , Traumatismos de los Dedos/diagnóstico , Esporotricosis/diagnóstico , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Cutaneous abscess is a localized collection of pus in the dermis and subcutaneous tissue usually caused by trauma. The authors report the case of a 30-year-old male patient, gardener, that presents an ulcerated plaque in the third right finger, caused by an aculeus plant wound. The examination of the lesion's exudate ruled out the existence of fungi and showed the presence of Staphylococcus aureus. The authors emphasize the sporotrichosis as an important differential diagnosis, especially in endemic areas, and the indication of the exudate culture is discussed.
Asunto(s)
Absceso/diagnóstico , Rosaceae , Piel/lesiones , Infecciones Cutáneas Estafilocócicas/diagnóstico , Absceso/microbiología , Adulto , Diagnóstico Diferencial , Exudados y Transudados , Traumatismos de los Dedos/diagnóstico , Humanos , Masculino , Esporotricosis/diagnóstico , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Puerto Rico (PR) is home to 10 indigenous species of snake. Alsophis portorricensis has traditionally been considered harmless. In 1961, Hageman classified A portorricensis as somewhere between "venomous" and "nonvenomous." In 1966, Heatwole and Banuchi reported the only case found in the literature of a "venomous" bite from Alsophis portorricensis. Only 6 cases of snakebite were reported to the PR Department of Health from 1998 to 2007; ecchymosis, swelling, and abnormal vital signs were noted in all of the cases. In 5 of these 6 cases, the captured snake was, in fact, identified as Alsophis portorricensis of the Colubridae family; in the remaining case, the description strongly suggests that it was the same species as the others. All bites were inflicted on fingers, which were presented for evaluation from 2 to 24 hours after the event. All documented cases report that the bite lasted from 1 to 4 minutes. All of the victims presented with localized pain and ecchymosis. Localized edema extended from the hand to the elbow in 4 cases, and up to the shoulder in 2 cases. All patients were treated symptomatically, observed at the Emergency Department (ED), and discharged home within 24 hours after the ED evaluation. All patients reported the resolution of symptoms within 1 week. Traditionally, PR has not been associated with any dangerous species of snake. These cases show that the second most abundant snake on the island can inflict a venomous bite, with local and systemic symptoms that warrant adequate preparation by the medical community.
Asunto(s)
Colubridae , Mordeduras de Serpientes/diagnóstico , Venenos de Serpiente/envenenamiento , Adolescente , Adulto , Anciano , Analgésicos/uso terapéutico , Animales , Equimosis/etiología , Edema/etiología , Servicio de Urgencia en Hospital , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/etiología , Traumatismos de los Dedos/terapia , Primeros Auxilios , Humanos , Masculino , Dolor/tratamiento farmacológico , Dolor/etiología , Puerto Rico , Mordeduras de Serpientes/complicaciones , Mordeduras de Serpientes/terapia , Adulto JovenRESUMEN
A clínica, o diagnóstico e as possibilidades terapêuticas das lesões da extremidade distal dos dedos (AU)
Clinical presentation, diagnosis and treatment of fingertip injuries (AU)
Asunto(s)
Humanos , Traumatismos de los Dedos/cirugía , Traumatismos de los Dedos/diagnóstico , Reimplantación , Traumatismos de los Tendones/diagnóstico , Traumatismos de los Tendones/terapia , Uñas/lesionesRESUMEN
El fenómeno de Raynaud consiste en la aparición paroxística de espasmo vascular, que afecta a pequeñas arterias y arteriolas cutáneas, de las extremidades. Se manifiesta con palidez extrema, que puede ir seguida de cianosis y posterior rubicundez durante la fase hiperémica. Se acompaña generalmente de disestesias y, en forma ocasional, también de dolor. Generalmente, presentan escasa repercusión sistémica asociada. Los principales desencadenantes son el frío y el estrés emocional. El bloqueo del ganglio estrellado es utilizado frecuentemente para el diagnóstico y tratamiento de múltiples sindromes dolorosos crónicos. Con el bloqueo de la actividad simpática, se produce una vasodilatación de los vasos de la extremidad superior, cabeza y cuello, siendo éste el sustrato para su utilización en cuadros de insuficiencias vasculares de las zonas inervadas. Presentamos el caso de un bloqueo de ganglio estrellado en una paciente con lesiones isquémicas digitales secundarias a un fenómeno de Raynaud primario.
The sudden onset of vascular spasm, affecting small arteries and skin arterioles of limbs is known as Raynaud's phenomenon. it includes severe paleness sometimes followed by cyanosis and redness during the hyperemic phase. Usual findings are dysestesias and ocassionally pain. Normally it causes a small systemic impact. The most relevant triggering factors are cold and emotional stress. Stellate Ganglion Block is frequently used to diagnose and treat several chronic pain syndromes. The sympathetic activity block causes the vasodilation of the arms, head and neck, and this is the substratum for using it in vascular impairment syndrome. We present a stellate ganglion block in a patient with isquemic digital lesions secondary to Raynaud phenomenon.
Asunto(s)
Humanos , Femenino , Anciano , Bupivacaína/administración & dosificación , Bupivacaína/uso terapéutico , Enfermedad de Raynaud/complicaciones , Isquemia/tratamiento farmacológico , Isquemia/terapia , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/etiología , Traumatismos de los Dedos/terapia , Dolor/tratamiento farmacológico , Ganglio Estrellado , Manejo del Dolor , VasodilataciónRESUMEN
El sindrome del nevo azul en tetina de goma, Síndrome de Bean, o Blue rubber bleb nevus es una rara entidad consistente en la presencia de malformaciones vasculares múltiples( hemangioma cavernoso) en piel y órganos internos, principalmente aparato digestivo. Complicaciones como sangrado gastrointestinal, anemia i coagulopatías, han sido documentadoas. Se comunica el caso de una niña de 12 años con "Sindrome del nevo azul en tetina de goma", que presento anemia y cuyo diagnóstico se realizó por biopsia y endoscopía digestiva(au)
Asunto(s)
Humanos , Femenino , Nevo Azul/complicaciones , Nevo Azul/diagnóstico , Nevo Azul/patología , Nevo Azul/terapia , Diagnóstico Diferencial , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/patología , Traumatismos de los Dedos/diagnóstico por imagen , Traumatismos de los Dedos/diagnóstico por imagenRESUMEN
El sindrome del nevo azul en tetina de goma, Síndrome de Bean, o Blue rubber bleb nevus es una rara entidad consistente en la presencia de malformaciones vasculares múltiples( hemangioma cavernoso) en piel y órganos internos, principalmente aparato digestivo. Complicaciones como sangrado gastrointestinal, anemia i coagulop'atías, han sido documentadoas. Se comunica el caso de una niña de 12 años con "Sindrome del nevo azul en tetina de goma", que presento anemia y cuyo diagnóstico se realizó por biopsia y endoscopía digestiva(au)
Asunto(s)
Humanos , Femenino , Diagnóstico Diferencial , Nevo Azul/complicaciones , Nevo Azul/diagnóstico , Nevo Azul/patología , Nevo Azul/terapia , Traumatismos de los Dedos , Traumatismos de los Dedos , Traumatismos de los Dedos/diagnóstico , Traumatismos de los Dedos/patologíaRESUMEN
Two soldiers are reported who sustained ring avulsion injuries while performing duties as part of Operation Provide Promise in Croatia (former Yugoslavia). These traction injuries inflicted on a ringed finger can present difficult diagnostic and treatment challenges in the field environment. They also can result in long-term disfigurement and disability. Due to the type of work performed and the equipment used by soldiers in the field environment, they are at particular risk for ring avulsion injuries. However, with appropriate education and precautions, these risks can be minimized.
Asunto(s)
Amputación Traumática/etiología , Traumatismos de los Dedos/etiología , Personal Militar , Traumatismos de los Tejidos Blandos/etiología , Adulto , Amputación Traumática/diagnóstico , Argentina/etnología , Croacia , Traumatismos de los Dedos/diagnóstico , Humanos , Masculino , Traumatismos de los Tejidos Blandos/diagnóstico , España/etnologíaRESUMEN
Hypothenar hammer syndrome is an infrequently diagnosed labor disease. We report a 51 years old male who used the medial aspect of his left hand as a hammer over the past 12 years. He presented with ipsilateral ring finger embolization. An angiogram demonstrated an ulnar artery occlusion at the hypothenar eminence. No other source of emboli was found and treatment was conservative. This disease is a consequence of repetitive traum aon the ulnar artery, that leads to vessel wall changes and promotes local thrombosis, distal embolization and eventually, occlusion in situ. Treatment options are conservative in case of occlusion or reconstruction with exclusion of the emboligeneous area
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Arteriopatías Oclusivas/diagnóstico , Arteria Cubital/lesiones , Nifedipino/administración & dosificación , Aspirina/administración & dosificación , Traumatismos de los Dedos/diagnóstico , Enfermedades Profesionales/diagnóstico , Electrocardiografía , Hipertensión/complicacionesRESUMEN
A ruptura fechada das polias digitais, sem lesäo dos tendöes flexores associada, constitui-se em quadro de difícil diagnóstico clínico. Na revisäo bibliográfica efetuada, näo encontramos descriçäo de patologia idêntica. O mecanismo envolvido nos dois casos descritos é o de força intensa de flexäo do dedo que encontra um obstáculo (força de extensäo) em sentido contrário. O quadro clínico constitui-se de edema, dor, hiperplasia e aumento do diâmetro ântero-posterior (fenômeno de arco-de-corda) na fase aguda e limite de flexoextensäo e rigidez articular na fase crônica. A técnica de Kleinert-Bennett (emprego do tendäo do palmar longo, em disposiçäo ziguezague) foi utilziada para a reconstruçäo do sistema de polias. O follow-up de seis anos mostrou funçäo normal dos dedos envolvidos
Asunto(s)
Persona de Mediana Edad , Humanos , Masculino , Articulaciones de los Dedos/cirugía , Traumatismos de los Dedos/cirugía , Traumatismos de los Dedos/diagnóstico , Métodos , RoturaRESUMEN
A punçäo aspirativa por agulha fina vem sendo amplamente utilizada no diagnóstico de neoplasias dos diversos órgäos, incluindo lesöes ósseas. No presente caso, ela foi o procedimento que diagnosticou cisto epidermóide de falange distal de paciente do sexo masculino de 32 anos de idade
Asunto(s)
Adulto , Humanos , Masculino , Biopsia con Aguja , Quiste Epidérmico/diagnóstico , Traumatismos de los Dedos/diagnóstico , Quiste Epidérmico/cirugíaRESUMEN
Este protocolo propöe uma sistematizaçäo do tratamento das L.E.R.- Lesäo por Esforço Repetitivo. É dirigido a todos os profissionais da área de saúde que diagnosticam, tratam e reabilitam os pacientes com quadro de dor e limitaçäo funcional do membro superior.