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At least 955 records · Page 53Linked to original sources
PubMed1991

The Darrach procedure defended: technique redefined and long-term follow-up.

Thirty-three patients with pain and decreased range of motion after traumatic derangement of the distal radioulnar and ulna-carpal joint were treated with a modified Darrach distal ulnar resection. Their ages ranged from 22 to 75 years (average, 50 years). Twenty-seven patients had Colles' or other distal radius fractures. Seven patients had ulnar resection for treatment of distal ulnar-carpal derangement. Follow-up averaged 54.4 months. The patients showed an average increase in extension of 58% and flexion increased by 40% (p less than 0.01). Pronation increased by 40% and supination increased by 60% (p less than 0.01). Average grip strength increased by 38% (p less than 0.05). Ninety-one percent good or excellent results were achieved with this procedure. The Darrach resection can predictably provide pain relief while improving strength and motion when attention is paid to minimal bony resection and meticulous soft tissue reconstruction.

Adult↗
PubMed2005

[Negative pressure pulmonary edema. Post-obstructive lung edema after use of a laryngeal mask].

A 31-year-old male patient was scheduled for surgical treatment of a distal radius fracture under general anaesthesia using a laryngeal mask airway and spontaneous ventilation. The intraoperative course was uneventful. During recovery, the patient strongly bit the laryngeal mask, producing a complete obstruction of the artificial airway in combination with very forceful inspiratory efforts until the mask was removed. In the recovery room the patient developed dyspnea and desaturation. A portable chest radiograph demonstrated bilateral alveolar infiltration suggesting pulmonary edema. The patient was transferred to the intensive care unit where drug therapy (furosemide and hydrocortisone) and treatment with the continuous flow continuous positive airway pressure (CF-CPAP) system led to complete recovery within 24 h.

Adult↗
PubMed1996

Hyaluronidase (Hyalase): a useful addition in haematoma block?

OBJECTIVE: To investigate whether hyaluronidase (Hyalase) is a useful and justified addition to haematoma block for pain relief. METHODS: The study was a randomised double blind trial of 33 consecutive patients attending the accident and emergency department for manipulation of distal radius fracture under haematoma block. Control patients received 1% lignocaine; the treatment group received 1% lignocaine plus 1500 IU hyaluronidase. Manipulation occurred 10 minutes after instituting the block. RESULTS: 16 patients received hyaluronidase, 17 received lignocaine only. One patient with unsuccessful manipulation was excluded. There was no significant difference between the two groups for any of three methods of pain assessment (P > 0.05, Mann Whitney). CONCLUSIONS: The addition of hyaluronidase does not increase the efficacy of the haematoma block when 10 minutes are allowed to elapse before manipulation, and the increased cost of adding (and risk of allergy) is not justified by any theoretical increased speed of analgesia.

Anesthetics, Local↗
PubMed1997

Radial avulsion of the triangular fibrocartilage complex in acute wrist trauma: a new technique for arthroscopic repair.

The advantages of arthroscopically assisted treatment of intraarticular distal radius fractures, especially the detection of additional carpal lesions, also focus attention on special surgical techniques for operating on these injuries within the same session. When we consider the biomechanical situation, various kinds of triangular fibrocartilage complex (TFCC) lesions, and their arthroscopic aspects, there are probably two possibilities for surgical treatment that are similar to arthroscopic meniscal surgery: resection of flap tears and the refixation of peripherally disinserted TFCC. Avulsions from the ulnar styloid or from the ulnar collateral ligament and the extensor carpi ulnaris tendon can easily and satisfactorily be treated by convenient arthroscopic suture techniques, whereas the reattachment of the triangular disc in the sigmoid notch is very tricky. This problem is solved by a recently developed procedure using the so-called T-Fix-device (Acufex), which provides the possibility of transosseus refixation by closed arthroscopic procedure and therefore guarantees the principle of minimal invasive surgery.

Arthroscopes↗
PubMed1993

[Anatomic studies of percutaneous bore wire osteosynthesis of the distal radius].

Modified percutaneous K-wire pinning has been used for unstable distal radius fractures groups A 2.2-3, A 3.1-3, B 1.1-2, B 2.1-2, B 3.3, C 1.1-3, C 2.1-3, and C 3.1-2 according to the ASIF-classification in 90 patients with good results. No tendinous rupture or any weakness respectively, infection or secondary dislocation either had occurred six months postoperatively. In five cadavers experimental anatomical studies had revealed possible lesions of the tendons of the brachioradialis muscle, the short and long wrist extensors, the long thumb abductor and his short extensor respectively as well as the superficial radial nerve and the cephalic vein. Abnormous sensations in the scar or in the region of distribution of the superficial radial nerve had occurred in every second patient but had subsided six months postoperatively. No permanent nerve lesion was found. There has been bleeding from the cephalic vein after the stab incision for exposure of the tip of the styloid process in every third patient but had healed uneventfully in every case.

Bone Wires↗
PubMed2003

[Reconstruction of the ruptured extensor pollicis longus tendon using a tendon interposition graft].

To restore function of the ruptured extensor pollicis longus (EPL) tendon, two operative principles have been described: reconstruction of the original tendon using a tendon interposition graft or a tendon transposition operation, most commonly transposition of the extensor indicis. From 1992 to 1998, we reconstructed the extensor pollicis longus tendon using an interposition graft in 58 patients. 48 patients were available for follow-up after a mean of 31 months. The mean age of the 25 women and 23 men was 49 years. The time between tendon rupture and reconstruction ranged from one to 40 weeks. The tendon rupture occurred in 19 patients following a radius fracture, in 22 patients without history of trauma and in seven patients it was due to a sharp injury. Using the clinical score of Geldmacher and Köckerling, five patients achieved a very good, 35 patients a good and eight patients a satisfactory result. No patient had a poor result. According to the statistical analyses, these results were independent of the age of the patients, the origin of the rupture or the time interval between rupture and tendon reconstruction. The average DASH score measured 14. Considering our results, secondary reconstruction of the original EPL tendon appears to be a valuable alternative to the commonly performed tendon transpositions. It yields good clinical results with little remaining functional impairment and without the need to sacrifice another functional motor. We strongly recommend this technique in patients who require an independent and strong extension of the index finger in their profession (surgeons, musicians) and in patients with severe trauma that does not allow the sacrifice of another intact motor unit.

Adolescent↗
PubMed2006

Two potential causes of EPL rupture after distal radius volar plate fixation.

Rupture of the extensor pollicis longus tendon can occur after volar plate fixation of dorsally comminuted distal radius fractures. We attempted to identify the etiology of extensor pollicis longus tendon injury after volar plate fixation of the distal radius and potential solutions to this problem. After describing two case reports, we examine six cadaveric specimens and retrospectively review 10 selected patients to evaluate possible technique refinements to minimize damage to the extensor pollicis longus tendon during volar plating of the distal radius. We identify specific screw holes in three commercially available volar distal radius plates that direct the drill bit or prominent screw tips into the third extensor compartment. In addition, after reduction and plate fixation, bone fragments or dorsal gapping may predispose the extensor pollicis longus tendon to injury. We recommend either using shorter screw lengths or leaving the implicated plate holes unfilled. In addition, we suggest consideration of an open assessment of the third extensor compartment, if indicated, as performed through a small dorsal incision ulnar to Lister's tubercle.

Adult↗
PubMed1997

[Computer-based training--a new method in surgical education and continuing education].

Computer-based training (CBT) programs teach the material of a specific field and at the same time offer various ways of objectively checking the knowledge gained. The interactive use of multimedia components, such as text, graphics, animation, sound, digital slide shows, videos and quizzes, facilitates the learning process. The aim of this study was the development and evaluation of a CBT program for use by surgeons teaching students. Using SuperCard, a teaching module for distal radius fracture (DRF) was developed, containing detailed clinical information. Video clips and vivid animation combine theoretical knowledge with practical experience. Fourth-year medical students (n = 103) were tested after using the module for 90 min. Other students (n = 47) served as the control group. In a 90-min lecture, DRF was discussed. In all evaluated criteria (distinctness, detailed description, presentation of materials, structure, motivation to learn, time saved while learning and memory retention), CBT gained 15-20% better scores than the lecture. Although 87% of the students stated that their experience with computers was limited or insufficient, 100% found the use of CBT systems helpful in student teaching. Most of them suggested the use of such programs as a exam preparation/self study method (90%) or as a supplement to a lecture (40%). Based on these evaluations, it is clear that CBT modules are an appropriate future teaching and learning system that will be well accepted. In conclusion, CBT programs should be integrated into medical education as a valuable supplement. With this aim, CBT systems should be developed and used at universities as an information system for the surgical residency program.

Achievement↗
PubMed2001

Despite clinical similarities there are significant differences between acute limb trauma and complex regional pain syndrome I (CRPS I).

In order to analyze the pathophysiology behind the clinical similarity acutely after limb trauma and in acute stages of complex regional pain syndrome (CRPS), 20 patients with external fixation after distal radius fracture (3.5 days after surgery) without signs of CRPS and 24 patients suffering from acute CRPS I (without nerve lesion; duration, 5 weeks) were investigated. Hyperalgesia to heat was tested by a feedback-controlled thermode, and to mechanical stimuli by an impact stimulator. The sympathetic nervous system was examined by measuring skin temperature (infra-red thermography), testing different sympathetic vasoconstrictor reflexes (laser-Doppler flowmetry) and quantitative sudometry after thermal load (thermoregulatory sweat test). We found hyperalgesia to heat after trauma (P<0.001), but not in CRPS, whereas mechanical hyperalgesia was present in both patient groups (trauma: P<0.001; CRPS: P<0.005). Skin temperature was significantly increased on the affected side in both patient groups (acute trauma: P<0.001; CRPS: P<0.005). However, sympathetic failure, as indicated by impairment of sympathetic vasoconstrictor reflexes (P<0.02) and hyperhidrosis (P<0.01), was found exclusively in CRPS patients. Our results indicate that pain and vasomotor disturbances may be generated by different mechanisms acutely after trauma and in acute CRPS. Despite the clinical similarity, additional changes in the peripheral or central nervous system are required for CRPS. In the light of our observations, it seems unlikely that CRPS is a simple exaggeration of post-traumatic inflammation.

Acute Disease↗
PubMed1995

[Load transmission through the wrist joint: a biomechanical study comparing the normal and pathological wrist].

This study was undertaken to elucidate the correlation, if any, between pressure loading and the progress of degenerative osteoarthritis in the human wrist. Nine fresh amputated forearms were used to produce i) a pathological model of a malunion after a distal radius fracture, ii) a model of a triangular fibrocartilage (TFC) tear, and iii) a model of a scapholunate dissociated wrist (involving three specimens for each model). On pressure loading, changes in the radioulno-carpal joint and in the midcarpal joint were measured using a pressure sensor. In the malunion of the distal radial end, we found that a pressure fluctuation occurred at more than a 20 degrees dorsal tilt with greater than ulnar +2 mm variance. The loads on the TFC surface and on the scaphoid surface increased, causing the pressure loading site to move dorsally. In the model of a partial TFC resection, sufficient decompression was achieved at the resection site for ulnar 0 mm variance. However, at +2.5 mm variance, the pressure loading caused a concentrated pressure to occur on the TFC surface and the decompression became ineffective. So for a +2.5 mm variance in this model, shortening the ulnar diaphysis is suggested as adequate for a clinical reduction in pressure. In the scapholunate dissociated model, we observed decreased pressure in the radioscaphoid articulation and scaphocapitate articulation, during volar rotation of the scaphoid, while there was increased pressure in the radiolunate and in the lunocapitate articulation. In all models, the focus of the increased pressure was correlated with radiographic findings as being the same as the site of morphological degeneration, suggesting a close correlation between abnormal pressure and the progression of degenerative osteoarthritis.

Biomechanical Phenomena↗
PubMed1991

[Fractures of the distal radius. Guidelines for treatment].

Fractures in the distal part of the radius are a common injury in the elderly and in an increasing number of young patients as well. In order to obtain optimal function it is essential, in older and younger patients alike, to secure anatomic length of the radius and anatomic congruency of the joint. Fractures with a tendency to secondary dislocation after primary good reduction should be recognized. Rereduction and fixation with percutaneous K-wires secure the position of the fracture. In some patients primary pinning or primary treatment with an external fixator should be considered, depending on the type of fracture. Guidelines are outlined for the treatment of this very frequent fracture.

Colles' Fracture↗
PubMed1992

[Plate osteosynthesis of the radius. Own implant and technique].

In 1989 and 1990, 46 acute distal radius fractures with die-punch compression cavities underwent open reduction and internal fixation using a new compression plate and surgical technique. In 34 of these patients, functional and radiological results after plate removal were studied. Surgical exposure was palmar or dorsal, or combined palmar with a supplementary dorsal incision, depending on the location of the compression cavity and the extent of fracture dislocation. A cortico-cancellous graft from the iliac crest was fitted into the compression cavity, thus supporting the reduced joint surface against the radius shaft. Superior maintenance of the reduction was achieved using cortico-cancellous instead of simple cancellous graft. A new titanius radius reconstruction plate was used for internal fixation. This two-fold support of the fracture allowed for earlier wrist mobilization.

Adolescent↗
PubMed1987

Simultaneous fractures of the distal radius and scaphoid.

Simultaneous fractures of the distal radius and the scaphoid are uncommon. A study of seven male patients who had sustained this fracture combination revealed the most frequent cause of the injury was a fall from a height. The distal radial fracture, usually unstable and intra-articular, was the principle fracture in this complex injury. In contrast, most of the scaphoid fractures were stable. Four of the radial fractures were treated by closed reduction and cast immobilization. In the remaining three, an external fixator was used to maintain the reduction. Four scaphoid fractures were immobilized in a cast, two were internally fixed, and one was left untreated. At an average follow-up period of 20 months (range from 12 to 52 months), all seven patients had regained satisfactory use of their hands. (Three results were classified as excellent and four good.) All scaphoid fractures healed. Transient avascular necrosis was noted in one scaphoid, but cleared within 5 months. Advanced radiocarpal arthritis developed in one wrist, but its presence did not adversely affect the late functional result.

Adolescent↗
PubMed1997

Long-term results of radioscapholunate fusion following fractures of the distal radius.

Fifteen patients with radioscapholunate (RSL) fusion for traumatic lesions of the radiocarpal junction, whose short-term results have been previously reported, were reassessed after an average follow-up time of 8 years. Five patients had undergone wrist fusion because of non-union or early progressive arthritis. Of the ten wrists with retained mobility, eight continued to function satisfactorily. Two wrists were painful for reasons other than secondary midcarpal arthritis. Patient satisfaction was comparable in both groups with the wrist score better for wrists with residual motion. The survival of RSL partial wrist fusion corresponded inversely with the number of preceding operations and the range of motion before partial fusion. Secondary midcarpal arthritis, if present, arose early and was well tolerated. Failures were strongly linked to technical mistakes and complications.

Adult↗