scholarly journals Contralateral Abdominal Pocketing in Salvation of Replanted Fingertips with Compromised Circulation

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Hyung-Sup Shim ◽  
Dong-Hwi Kim ◽  
Ho Kwon ◽  
Sung-No Jung
Keyword(s):  
Range Of Motion ◽  
Chart Review ◽  
Patient Comfort ◽  
Wound Complications ◽  
Dash Score ◽  
Postoperative Wound ◽  
Medical Chart Review ◽  
Lower Abdominal Quadrant ◽  
The Mean ◽  
Abdominal Quadrant

Abdominal pocketing is one of the most useful methods in salvation of compromised replanted fingertips. Abdominal pocketing has generally been performed in the ipsilateral lower abdominal quadrant, but we have also performed contralateral pocketing at our institute. To determine which approach is more beneficial, a total of 40 patients underwent an abdominal pocketing procedure in either the ipsilateral or contralateral lower abdominal quadrant after fingertip replantation. Dates of abdominal pocketing after initial replantation, detachment after abdominal pocketing, range of motion (ROM) before abdominal pocketing, and sequential ROM after the detachment operation and date of full ROM recovery and Disabilities of Arm, Shoulder, and Hand questionnaire (DASH) score were recorded through medical chart review. Mean detachment date, mean abduction of shoulder after the detachment operation, and mean days to return to full ROM were not significantly different between the ipsilateral and contralateral pocketing groups. However, the mean DASH score was significantly lower in the contralateral group than the ipsilateral group. There were also fewer postoperative wound complications in the contralateral group than in the ipsilateral group. We, therefore, recommend contralateral abdominal pocketing rather than ipsilateral abdominal pocketing to increase patient comfort and reduce pain and complications.

scholarly journals Reconstruction of finger joints using autologous rib perichondrium – an observational study at a single Centre with a median follow-up of 37 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Muder ◽  
Ola Nilsson ◽  
Torbjörn Vedung
Keyword(s):  
Range Of Motion ◽  
Young Patients ◽  
Long Term Results ◽  
Dash Score ◽  
Finger Joints ◽  
Joint Reconstruction ◽  
Additional Surgery ◽  
Contralateral Hand ◽  
The Mean

Abstract Background Gratifying long-term results are difficult to achieve when reconstructing osteoarthritic finger joints. Implant surgery is the most commonly used method to restore function and dexterity. However, all types of implant have disadvantages and may be a less favorable option in some cases, especially in young patients with a long expected lifetime and high demands on manual load. Implant related complications as loosening, instability, subsidence and stiffness are the main concerns. In this context, joint reconstruction using rib perichondrium might be a reasonable alternative in selected cases. The aim of the study was to evaluate the long-term results of finger joint reconstruction using rib perichondrial transplantation. Methods The study group (n = 11) consisted of eight individuals reconstructed in the proximal interphalangeal (PIP) joints and three reconstructed in the metacarpophalangeal (MCP) joints during 1974–1981. All patients were evaluated at clinical visits (median: 37 years after perichondrial transplantation, range: 34–41 years) using radiographs, disability in arm-shoulder-hand (DASH) score, Visual Analog Scale (VAS), range-of-motion (ROM) and manual strength (JAMAR). Results None of the 11 patients had undergone additional surgery. All of the PIP-joints (n = 8) were almost pain-free at activity (VAS 0,6) (range 0–4), had an average range-of-motion of 41 degrees (range 5–80) and a mean DASH-score of 8,3 (range 1–51). The mean strength was 41 kg compared to 44 kg in the contralateral hand (93%). The three MCP joints were almost pain-free at activity (VAS 0,7), (range 0–1). The ROM was on average 80 degrees (range 70–90) and the mean DASH-score was 2 (range 1–3). The mean strength was 43 kg compared to 53 kg in the contralateral hand (81%). Conclusions Perichondrium transplants restored injured PIP and MCP joints that remained essentially pain-free and mostly well-functioning without need for additional surgeries up to 41 years after the procedure. Additional studies are needed to evaluate long-term results in comparison to modern implants and to better describe the factors that determine the outcome of these procedures. Level of evidence Level IV, Therapeutic Study.

scholarly journals Functional outcome of locking anatomical plate in extra articular fractures of the distal humerus

2019 ◽  
Vol 5 (3) ◽  
pp. 443
Author(s):  
Amit Chandrakant Supe ◽  
Nikhil Dilip Palange ◽  
Eknath D. Pawar ◽  
Neetin P. Mahajan
Keyword(s):  
Range Of Motion ◽  
Functional Outcome ◽  
Distal Humerus ◽  
Radial Nerve Palsy ◽  
Dash Score ◽  
Articular Fractures ◽  
Early Return ◽  
Humerus Fractures ◽  
The Mean ◽  
Distal Humerus Fractures

<p class="abstract"><strong>Background:</strong> Extra articular distal humerus fractures are difficult to treat with conventional implants like intra medullary nail, 4.5 DCP and dual plate. The present study aims to study the functional outcome of the extra articular distal humerus plate (EADHP).</p><p class="abstract"><strong>Methods:</strong> 48 patients with displaced extra articular distal humerus fractures were included in the study. Inclusion criteria were age more than 18 years, closed fractures with or without radial nerve palsy and less than 3 weeks old trauma. Patients aged less than 18 years, those having open fractures, fractures more than 3 weeks old, non – unions and pathological fractures were excluded from the study. All patients were operated with EADHP. Clinically, the outcome was assessed by the disability of arm, shoulder and hand (DASH) score and elbow range of motion radiologically, union was evaluated on anteroposterior and lateral radiographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 48 patients, 12 had AO type 12 A1 fracture, 26 patients had type B1 fractures and remaining 10 had type C1 fractures. Mean DASH score at final follow up was 18.1; range being 12.6 to 35.7 points. The mean elbow range of motion was 0 to 130 degrees (range: 120 to 140 degrees). The mean duration for complete radiological fracture union was 14 weeks, range being 12 to 18 weeks.</p><p class="abstract"><strong>Conclusions:</strong> The extraarticular distal humerus plate is an ideal implant for the fixation of distal humerus fractures since it provides good stability of fracture and enables early return to function.</p>

TREATMENT OF DISTAL RADIAL FRACTURES WITH THE DVR-A PLATE — THE EARLY BRISTOL EXPERIENCE

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 159-167 ◽  
Author(s):  
J. Loveridge ◽  
N. Ahearn ◽  
C. Gee ◽  
D. Pearson ◽  
S. Sivaloganathan ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Distal Radial Fracture ◽  
Consecutive Series ◽  
Dash Score ◽  
X Rays ◽  
Radial Inclination ◽  
Sagittal Tilt ◽  
Radial Length ◽  
The Mean

Aim: The aim of the study was to assess how adequately distal radial fracture reduction was reproduced and maintained with the distal volar radius anatomic DVR-A (Biomet, Inc) locking plate. Methods: We looked at a consecutive series of 111 patients treated with the DVR-A plate at our institution from 2007–2010. The preoperative, intra-operative, and postoperative films were reviewed. The AO and Frykman classification was recorded. The sagittal tilt, radial inclination, and radial length were measured on intra-operative X-rays and compared with final follow-up X-rays. The last recorded range of motion at follow-up and a functional assessment using the Disabilities of the Arm, Shoulder, and Hand (DASH) score was recorded. Results: At final follow-up a mean radial inclination of 22.22 degrees (11 to 38 degrees), radial height of 11.85 mm (6 to 18 mm), and sagittal tilt of 6.71 degrees volar (-9 to 19 degrees) was achieved. From initial post-operative films, to final follow-up X-rays there was a mean increase of 0.17 degrees in radial inclination, a mean loss of 0.36 mm radial height, and a mean loss of 2.17 degrees volar tilt. The mean extension was 46.8 degrees, flexion 48.3 degrees, pronation 77.4 degrees, supination 74.8 degrees, radial deviation 15.3 degrees and the ulnar deviation 19 degrees. The mean DASH score was 12.8 (0–68). Conclusion: The DVR-A plate achieved a highly satisfactory reduction of radial length and radial inclination, with a small loss of volar sagittal tilt at final follow-up. A good functional outcome was reported, with a satisfactory range of motion achieved. The DVR-A plate is a safe and effective treatment for unstable and intra-articular displaced distal radius fractures, particularly in younger patients, in the short term.

Four-Corner Arthrodesis Using the Quad Memory Staple

2009 ◽  
Vol 34 (2) ◽  
pp. 252-255 ◽  
Author(s):  
E. A. VAN AMERONGEN ◽  
A. H. SCHUURMAN
Keyword(s):  
Range Of Motion ◽  
Compressive Property ◽  
Dash Score ◽  
Ulnar Deviation ◽  
Non Union ◽  
Radial Deviation ◽  
Pin Fixation ◽  
The Mean ◽  
Simple Fixation

Range of motion, pain, consolidation and complications were evaluated for nine patients who underwent four-corner arthrodesis using the Quad Memory Staple (QMS) at a mean follow-up of 44 months. The mean pre-operative range of motion was 50° extension, 62° flexion, 9° radial deviation and 24° ulnar deviation. The postoperative range of motion was similar to previous studies at 32° extension, 31° flexion, 15° radial deviation and 20° ulnar deviation. The grip strength was 28 kg pre-operatively and 26 kg postoperatively. The mean pain score improved from 41 to 23 and the Disabilities of Arm, Shoulder, and Hand (DASH) score from 24 to 20. Non-union, haematoma and wound infection were not seen and eventually all four-corner fusions were consolidated. The main advantages of the QMS are its compressive property and the simple fixation technique. It gives good stability, enables early rehabilitation and avoids the risks of pin fixation methods.

scholarly journals Distal Articular Fractures of the Humerus: Surgical Approach with Dynamic Elbow external Fixator

2020 ◽  
Vol 48 (01) ◽  
pp. 002-009
Author(s):  
Marcio Aurelio Aita ◽  
Ricardo Kaempf de Oliveira ◽  
Douglas Hideki Ikeuti ◽  
Gustavo Mantovani Ruggiero ◽  
Fernando Luvizoto de Carvalho ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Fixator ◽  
Humeral Fractures ◽  
Radiographic Analysis ◽  
Posttraumatic Arthritis ◽  
Dash Score ◽  
Articular Fractures ◽  
Flexion Extension ◽  
Distal Humeral Fractures ◽  
The Mean

Abstract Purpose To measure clinical and radiographic outcomes using external fixation in distal humeral fractures. Methods A total of 10 elderly patients, with a mean age of 71 (range 64–84 years) years old, with unstable distal humeral fractures were treated by percutaneous reduction and fixation with an articulated external fixator. The patients were assessed on range of elbow motion, patient disabilities of the arm, shoulder, and hand (DASH), and pain visual analog scale (VAS) and radiographic evaluation at 12 months. Results The mean range of motion was 134° of flexion, extension was of - 5°. All of the elbows were clinically stable. The mean VAS was 2.2, and the mean DASH score was 14.3. Radiographic analysis showed satisfactory reduction and consolidation. All of the patients showed congruence of concentric humerus-ulnar and radius and no patient had joint stiffness or posttraumatic arthritis of the elbow. Regarding complications, we observed a patient who presented with pain in the location of the ulnar pin, which was resolved with the removal of the pin. After two months, another patient had pneumonia and died. The follow-up was of 15.44 months. Conclusions A radiographic analysis of the patients showed fracture healing with joint congruity. In the functional clinical aspect, it was noted that patients had functional range of motionType of study/level of evidence Therapeutic IV

scholarly journals Feasibility of Radial Endobronchial Ultrasound-Guided Bronchoscopic Cryobiopsy without Fluoroscopy for Lung Parenchymal Lesions

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Chih-Hao Chang ◽  
Chung-Shu Lee ◽  
Shih-Hong Li ◽  
Fu-Tsai Chung ◽  
Chih-Wei Wang ◽  
...  
Keyword(s):  
Chart Review ◽  
Endobronchial Ultrasound ◽  
Chang Gung Memorial Hospital ◽  
Ultrasound Guided ◽  
Lung Lesions ◽  
Specimen Diameter ◽  
Medical Chart Review ◽  
Peripheral Lung ◽  
The Mean ◽  
The Impact

Background. Cryobiopsy is used to biopsy peripheral lung lesions through flexible bronchoscopy with fluoroscopic guidance. However, fluoroscopy is not available at some institutions. This study evaluated the feasibility of radial endobronchial ultrasound-guided bronchoscopic cryobiopsy without fluoroscopy. Methods. This retrospective study was conducted at Chang Gung Memorial Hospital, Linkou branch, in Taiwan. This study enrolled patients who received bronchoscopy examinations with cryotechnology between July 2014 and June 2016. The data were collected through medical chart review. Results. During the study period, 101 patients underwent bronchoscopy examinations with cryotechnology. Ninety patients with endobronchial tumors were excluded from this study. Eleven patients who underwent radial endobronchial ultrasound-guided bronchoscopic cryobiopsy for lung parenchymal lesions were enrolled into this study. The mean age was 61.1 ± 13.8 years. Five patients were men, and the other six were women. The number of cryobiopsies ranged from 1 to 3. In the histological biopsies, the mean specimen diameter was 0.53 ± 0.23 cm, and the mean biopsy area was 0.20 ± 0.19 cm2. Nine of 11 patients had pathological diagnoses. No complications, including pneumothorax, respiratory failure, or major bleeding, were recorded after the procedure. Conclusions. Endobronchial ultrasound is used to ensure biopsy location, and endobronchial ultrasound-guided cryobiopsy is a feasible technique to biopsy peripheral lung lesions in selected cases at institutions without fluoroscopy equipment. This study provided some rationale for further studies examining the impact of fluoroscopy.

scholarly journals Transversus abdominis release versus perforator preseving anterior component separation in repair of large midline incisional hernia

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A K Abdallah ◽  
K H Gad ◽  
A A Darwish ◽  
I M Abdelmaksoud
Keyword(s):  
Postoperative Pain ◽  
Incisional Hernia ◽  
Operative Time ◽  
Component Separation ◽  
Transversus Abdominis ◽  
Wound Complications ◽  
Transversus Abdominis Release ◽  
Postoperative Wound ◽  
The Mean ◽  
Anterior Component Separation

Abstract Background Ventral hernia repair can be challenging, particularly in patients with serious comorbidity. Perforator preserving anterior component separation (ACS) by transverse skin incisions for external oblique aponeurosis release preserves both the rectus abdominis myocutaneous perforator vessels that supply the overlying skin and the connection between the subcutaneous fat and anterior rectus sheath, thereby reducing subcutaneous dead space and potentially improving overlying skin flap vascularity. Also posterior component separation via transversus abdominis release (TAR) provides effective fascial advancement while reducing wound morbidity during abdominal wall reconstructions. Both techniques give better results than classic ACS. Objectives to evaluate postoperative morbidity and recurrence rate when using transversus abdominis release technique in management of large midline incisional hernia in comparison with open perforator preserving anterior component separation. Patients and Methods the present study is a prospective study that was conducted at Ain Shams University Hospitals in Egypt, between October 2016 and October 2018. It included sixty (60) patients with large midline incisional hernia divided into two groups. First group include thirty patients who underwent transversus abdominis release with retromuscular polyprolene mesh placement. Second group include also thirty patients that underwent open perforator preserving anterior component separation and also with retromuscular placement of polyprolene mesh. Patients compared as regards operative time, length of hospital stay, postoperative pain, postoperative ileus, postoperative wound complications, rate of recurrence. Results Patients in both groups were similar with respect to age, the patients ages ranged from 20 to 70 years, with mean age in both groups around 46 years and between 20-23% have DM in each group. Perforator preserving technique has less operative time by about 40 minutes when compared with TAR technique. The postoperative pain assessment at 48hrs postoperative show that the mean pain score for TAR was (6.77 ± 1.70) and for perforator preserving group (5.47 ± 1.85). We also found that the mean hospital stay was slightly higher when performing TAR technique (5.2days) while it was (4.3days) after perforator preserving approach. There is nearly equal incidence of postoperative wound complications and also no statistically significant different rate of recurrence between two methods Conclusion both TAR and perforator preserving technique are effective and reliable method in experienced hands and if there is no special indication to one of them, the choice between both should depend on surgeon preference and experience.

scholarly journals A Fifteen-Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 110 ◽  
Author(s):  
Cengiz Güney ◽  
Abuzer Coskun
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Open Surgery ◽  
Acute Abdominal Pain ◽  
Case Series ◽  
Lower Abdominal Quadrant ◽  
Preservation Of Fertility ◽  
Laparoscopic Intervention ◽  
The Mean ◽  
Abdominal Quadrant

Isolated tubal torsions presenting to the emergency department are a very rare cause of pediatric acute abdominal pain. Since making the diagnosis early is of importance in terms of affecting tubal damage and fertility, we aimed to evaluate cases of isolated tubal torsions in light of the literature. This study included 10 patients under 18 years of age who presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5 ± 1.43 years (range: 12–17 years). The demographic characteristics, surgical findings and techniques, and concomitant pathology results of these patients were retrospectively evaluated. The reason for presenting to the emergency department for the 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 h in seven patients (70%) and more than 24 h in three patients (30%). Of the patients, nine (90%) had tenderness in the lower abdominal quadrant, five (5%) had defense, and three (30%) had rebound. Nausea, vomiting and leukocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Eight patients (80%) underwent open surgery and two (20%) underwent laparoscopic intervention. Detorsion was performed on five (50%) patients and salpingectomy was performed on five (50%) patients. Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the preservation of fertility.

scholarly journals Morbid Obesity Increases the Risk of Postoperative Wound Complications, Infection, and Repeat Surgical Procedures Following Upper Extremity Limb Salvage Surgery for Soft Tissue Sarcoma

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 114-120 ◽  
Author(s):  
Matthew T. Houdek ◽  
Anthony M. Griffin ◽  
Peter C. Ferguson ◽  
Jay S. Wunder
Keyword(s):  
Morbid Obesity ◽  
Soft Tissue ◽  
Upper Extremity ◽  
Salvage Surgery ◽  
Wound Complications ◽  
Limb Salvage Surgery ◽  
Class Iii ◽  
Postoperative Wound ◽  
The Mean ◽  
Nonobese Patients

Background: Obesity is a known risk factor for wound complications; however, unlike elective upper extremity procedures, where obesity can be modified preoperatively, excision of soft tissue sarcomas (STSs) is not elective, and as such, obesity cannot be modified. There is a paucity of data concerning the impact of obesity on wound healing in upper extremity sarcoma surgery. Methods: A total of 261 (159 males and 102 females) patients with a STS of the upper extremity from 2006-2014 were reviewed. The mean age and body mass index (BMI) were 56 (18-97) years and 26.6 (15.4-40.8) kg/m2, respectively. Sixty-nine patients (26%) were classified as obese (BMI ⩾30 kg/m2): class I (obese, BMI = 30-34.9 kg/m2; n = 48, 18%), class II (severely obese, BMI = 35.0-39.9 kg/m2; n = 16, 6%), and class III (morbidly obese, BMI ≥ 40 kg/m2; n = 5, 2%). Functional outcomes were also compared between obese and nonobese patients using the Musculoskeletal Tumor Society (MSTS) 1993 rating system and Toronto Extremity Salvage Scores (TESS). Results: Forty-nine patients (19%) sustained a wound dehiscence, delayed healing, or infection. Class III obesity increased the risk of wound complications (hazard ratio [HR] = 8.19, 95% confidence interval [CI] = 1.96-22.96, P < .001) and infection (HR = 10.09, 95% CI = 1.60-34.83, P = .01). There was no difference in the mean TESS (93 vs 90, P = .13) or MSTS93 (95 vs 93, P = .39) between obese and nonobese patients. Conclusions: The results of this study indicate morbid obesity significantly increased the risk of a postoperative wound complication and infection. However, following upper extremity limb salvage surgery, obese patients should expect to have excellent functional outcome.

scholarly journals A Fifteen Year Analysis of Rare Isolated Fallopian Tube Torsions in Adolescent Children: A Case Series

2019 ◽  
Author(s):  
Cengiz Güney ◽  
Abuzer Coskun
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Fallopian Tube ◽  
Acute Abdominal Pain ◽  
Case Series ◽  
Early Period ◽  
Lower Abdominal Quadrant ◽  
Laparoscopic Intervention ◽  
The Mean ◽  
Abdominal Quadrant

Isolated fallopian tube torsions presenting to the emergency department are a very rare cause of childhood acute abdominal pain. Since the diagnosis to be made in the early period is of importance in terms of affecting tubal damage and fertility, it was aimed to evaluate the cases in the light of literature. Materials and Methods: This study included 10 patients under 18 years of age presented to the emergency department with abdominal pain between January 2003 and December 2018. The mean age was 14.5&plusmn;1.43 years (range: 12-17years). The demographic characteristics, surgical findings, and methods, concomitant pathology results of these patients were retrospectively evaluated. Results: The reason for admitting to the emergency department of 10 patients included in the study was abdominal pain. The mean duration of hospital admission with pain was 4.97 days. The onset of pain was less than 24 hours in 7 patients (70%) and was more than 24 hours in three patients (30%). Of the patients, 9 (90%) had tenderness in the lower abdominal quadrant, 5 (5%) had the defense, and 3 (30%) had a rebound. Nausea, vomiting, and leucocytosis were present in 50% of the cases. Right and left tubal involvement of the cases was equal. Seven (70%) of the isolated tubal torsions were accompanied by paraovarian cysts. Of the patients, 8 (80%) underwent open surgery and 2 (20%) underwent laparoscopic intervention. Detorsion was performed in 5 (50%) and salpingectomy was performed in 5 (50%) cases. Conclusion: Isolated tubal torsion should be considered in children presenting with acute abdominal pain in early adolescence. Early diagnosis is important for the maintenance of fertility.

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