BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the r...BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.展开更多
BACKGROUND Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis(JIA)with progressive disease course,polyarticular involvement and failure of methotrex...BACKGROUND Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis(JIA)with progressive disease course,polyarticular involvement and failure of methotrexate treatment.AIM To describe features of JIA,associated with wrist arthritis.METHODS Data from about 753 JIA patients were included in this retrospective cohort study.The clinical and laboratory features of patients with and without wrist involvement were analyzed.RESULTS Wrist involvement was found in oligoarthritis(5.8%),RF(−)/RF(+)polyarthritis(44.9%/15.0%),enthesitis-related arthritis(17.7%),and systemic(58.6%)JIA categories.Unilateral wrist involvement was typical for oligoarthritis patients,bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories.Wrist arthritis was found to be associated with female sex,a low incidence of uveitis,and more indications of systemic inflammation,including elevated levels of C-reactive protein,erythrocyte sedimentation rate,and platelets,as well as involvement of the cervical spine,temporomandibular,shoulder,elbow,metacarpophalangeal,proximal interphalangeal,distal interphalangeal,hip,ankle,and tarsus arthritis.The number of patients with hip osteoarthritis and hip replacement was also higher.Wrist arthritis was associated with a lower probability of achieving remission[hazard ratio(HR)=1.3(95%CI:1.0-1.7),P=0.055],and a higher probability of being treated with biologics[HR=1.7(95%CI:1.3-2.10,P=0.00009)].CONCLUSION Wrist arthritis in JIA patients is a marker of a severe disease course,characterized by more intensive inflammation,unfavorable outcomes,and.requiring more intensive treatment with early administration of biologics.Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.展开更多
Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of ...Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of construction of dynamic wrists. Type I-3 and Ⅱ-6 dynamic compliant wrists have been designed and made. Prblems in the production of compliant elements and the connection between compliant elements and wrists were also solved. A study on the results of tests of the function of two kinds of dynamic compliant wrists shows that the dynamic compliant wrist's compliancy function can be improved by adding metallic materials having higher longitudinal and transverse rigidity into the softer elstomer. And the design Principle is proved to be feasible and practicable. It can be expected that the use of dynamic compliant wrist will greatly lower the technical requirements of the shaft-hole assembly and the requirements in the resetting accuracy.展开更多
In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) incr...In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.展开更多
Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data ...Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.展开更多
BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiop...BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature.A total of 43 articles and 61 cases were included in the literature review.Our case had a usual presentation:it was similar to those in the literature.The affected population was mainly older adults,with an average age of 59.43(range,3 to 90)years.The male-to-female ratio was 1.54:1(37/24).Most of them showed limited swelling and pain,only 23.0%had carpal tunnel symptoms,and the average disease duration was 18.03(0.5-60)mo.Wrist flexor tendon sheath involvement was the most common(95.1%,58/61),and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis(34.4%,21/61),nontuberculous mycobacteria(24.6%,15/61),idiopathic tenosynovitis(31.1%,19/61),and others(9.84%,6/61).There were 10 patients with recurrences;in 6 of them,were due to non-tuberculous mycobacterial infections.CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation,and established a clinical management algorithm for wrist tenosynovitis with rice bodies,which can provide some reference for our clinical diagnosis and treatment.The symptoms of rice-body bursitis of the wrist are insidious,nonspecific,and difficult to identify.The aetiology is mainly idiopathic tenosynovitis and mycobacterial(tuberculosis or non-tuberculous)infections;the latter are difficult to treat and require long-duration systemic combination antibiotic therapies.Therefore,before a diagnosis of idiopathic tenosynovitis is made,we must exclude other causes,especially mycobacterial infections.展开更多
BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS w...BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.展开更多
Wrist cracks are the most common sort of cracks with an excessive occurrence rate.For the routine detection of wrist cracks,conventional radiography(X-ray medical imaging)is used but periodically issues are presented ...Wrist cracks are the most common sort of cracks with an excessive occurrence rate.For the routine detection of wrist cracks,conventional radiography(X-ray medical imaging)is used but periodically issues are presented by crack depiction.Wrist cracks often appear in the human arbitrary bone due to accidental injuries such as slipping.Indeed,many hospitals lack experienced clinicians to diagnose wrist cracks.Therefore,an automated system is required to reduce the burden on clinicians and identify cracks.In this study,we have designed a novel residual network-based convolutional neural network(CNN)for the crack detection of the wrist.For the classification of wrist cracks medical imaging,the diagnostics accuracy of the RN-21CNN model is compared with four well-known transfer learning(TL)models such as Inception V3,Vgg16,ResNet-50,and Vgg19,to assist the medical imaging technologist in identifying the cracks that occur due to wrist fractures.The RN-21CNN model achieved an accuracy of 0.97 which is much better than its competitor`s approaches.The results reveal that implementing a correct generalization that a computer-aided recognition system precisely designed for the assistance of clinician would limit the number of incorrect diagnoses and also saves a lot of time.展开更多
Negative step response experimental method is used in wrist force sensor＇s dynamic performance calibration. The exciting manner of negative step response method is the same as wrist force sensor＇s load in working. T...Negative step response experimental method is used in wrist force sensor＇s dynamic performance calibration. The exciting manner of negative step response method is the same as wrist force sensor＇s load in working. This experimental method needn＇t special experiment equipments. Experiment＇s dynamic repeatability is good. So wrist force sensor＇s dynamic performance is suitable to be calibrated by negative step response method. A new correlation wavelet transfer method is studied. By wavelet transfer method, the signal is decomposed into two dimensional spaces of time-frequency. So the problem of negative step exciting energy concentrating in the low frequency band is solved. Correlation wavelet transfer doesn＇t require that wavelet primary function be orthogonal and needn＇t wavelet reconstruction. So analyzing efficiency is high. An experimental bench is designed and manufactured to load the wrist force sensor orthogonal excitation force/moment. A piezoelectric force sensor is used to setup soft trigger and calculate the value of negative step excitation. A wrist force sensor is calibrated. The pulse response function is calculated after negative step excitation and step response have been transformed to positive step excitation and step response. The pulse response function is transferred to frequency response function. The wrist force sensor＇s dynamic characteristics are identified by the frequency response function.展开更多
BACKGROUND Acute hand and wrist injuries are common and may lead to long-term disability if not managed adequately.Claims for negligence have been increasing in medical practice over the past few decades,with hand and...BACKGROUND Acute hand and wrist injuries are common and may lead to long-term disability if not managed adequately.Claims for negligence have been increasing in medical practice over the past few decades,with hand and wrist injuries and their treatment representing a significant percentage of orthopedic surgery lawsuits.There is no available literature regarding medical malpractice claims in hand and wrist injuries and surgery in Greece.AIM To identify claims related to hand and wrist trauma and surgery and to define the reasons of successful litigations.METHODS We performed a retrospective study of all legal claims of negligence for hand and upper extremity surgery that went to a trial,attributed to all surgical specialties,in Greece for a 20-year period.Data was further analyzed to identify claims related to hand and wrist trauma and surgery.RESULTS There were six malpractice claims related to hand and wrist trauma that ended in a trial.A missed diagnosis,which resulted in failure of initial management of the injury,was the main reason for a claim.Three of the six cases resulted in complete or partial loss of a finger.Two cases are still open,requiring an expert witness’s report,two cases were closed in favor of the defendant,and two cases were closed in favor of the plaintiff with a mean compensation of€2000(€1000-€3000).CONCLUSION Missed diagnosis was the main reason for a malpractice claim.Better understanding of factors leading to successful claims will help surgeons improve their practice to minimize legal implications and litigation.展开更多
The transfer matrix of wrist force sensor is important for decoupling theoutput signals and enhancing the precision of wrist force sensor.This paper solves thetransfer matrix from the realization of optimal approximat...The transfer matrix of wrist force sensor is important for decoupling theoutput signals and enhancing the precision of wrist force sensor.This paper solves thetransfer matrix from the realization of optimal approximation of polynomial.First,thegeneral transfer matrix algorithm in the sense of L^2 and two kinds of modified algorithmare proposed.Then,starting from uniform approximation,the optimal transfer matrixalgorithm is offered and solved by the use of linear programming.The results of experi-ment and computation prove that these algorithms are effective.展开更多
AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy vol...AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers(6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjectswere asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T(Verio-Siemens) using volume interpolated breath hold examination(VIBE) and dual echo steady state(DESS) MRI sequences. Cartilage cross sectional area(CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpalphalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter(14.1%) and intra(2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE(2.4%) and the DESS(4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.展开更多
Introduction and Aims—The Growth stage of a patient can have considerable influence on diagnosis, treatment goals, timing and planning and the eventual outcome of orthodontic/orthopedic treatment. The purpose of this...Introduction and Aims—The Growth stage of a patient can have considerable influence on diagnosis, treatment goals, timing and planning and the eventual outcome of orthodontic/orthopedic treatment. The purpose of this study was to analyze associations between the cervical vertebrae maturation score (CVMS) and skeletal maturation index (SMI). The second objective was to determine the reproducibility of the measurements on lateral cephalograms and hand-wrist radiographs. Materials and Methods—Lateral cephalometric and left hand-wrist radiographs of 92 untreated subjects (44 females and 48 males) aged from 8 to 17 years were obtained from the files of the Columbia University, Division of Orthodontics and measured for growth stage using cervical vertebrae and hand-wrist methods. Results—A high correlation was revealed between the hand-wrist and cervical vertebrae measurements. The Spearman’s rho correlation coefficient was 0.925 and significant at the 0.01 level. The correlation between hand-wrist and age (0.665, p < 0.01) was slightly greater than that of the CVMS (0.611, p < 0.01). Intra rater reliability was high. When the three categorically modified methods of the Fishman’s 11 skeletal maturation stages in hand and wrist analysis were used to compare with CVMS, methods 2 and 3 were both statistically significantly different according to the Wilcoxon signed ranks test and the Sign test at a significance level of less than 0.05. However, for method 1, the tests showed probability scores of 0.028 and 0.151, respectively, showing no significant difference at the 0.01 level in the Wilcoxon Signed Ranks Test, and no significant difference in the 0.01 and 0.05 level in the Signed Test. Conclusions—The Fishman’s hand and wrist skeletal maturation index and Bacetti’s cervical vertebrae maturation stages are both useful tools in evaluating growth stages. Fishman’s hand-wrist method is slightly more accurate.展开更多
In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There ...In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There is a lack of literature describing the normal range of wrist radiographic parameters in literature. As a result, a retrospective study was carried out. Patients who underwent standard wrist x-rays during the period February 2012 to February 2013 (one single year) were retrospectively reviewed. 71 patients were included. Scapholunate angle was 54.7° (±6.5°). Scapholunate interval was 2.0 mm (±0.4 mm). Ulnar variance was +1.0 mm (±1.8 mm). Carpal height was 31.8 mm (±3.0 mm). Radial inclination was 25.1° (±2.1°). All 71 patients had 1 sesamoid bone at first metacarpal. 16.9% (12 out of 71) patients had positive cortical ring signs. All these parameters are valuable clinically, especially in monitoring of the wrist disease progression, in the design of wrist implants and for future clinical research.展开更多
文摘BACKGROUND Occupational hand and wrist injuries(OHWIs)account for 25%of work-related accidents in low-and middle-income countries.In Colombia,more than 500000 occupational accidents occurred in 2021,and although the rate declined to less than 5%in 2020 and 2021,at least one in four accidents involved a hand or wrist injury.AIM To describe the OHWIs in workers seen at the emergency room at a second-level hospital in Colombia.METHODS An observational study was performed using data from workers who experienced OHWIs and attended a second-level hospital,between June,2020 and May,2021.The overall frequency of OHWIs,as well as their distribution by sociodemo-graphic,clinical,and occupational variables,are described.Furthermore,association patterns between sex,anatomical area(fingers,hand,wrist),and type of job were analyzed by correspondence analysis(CA).RESULTS There were 2.101 workers treated for occupational accidents,423(20.3%)were cases of OHWIs,which mainly affected men(93.9%)with a median age of 31 years and who worked mainly in mining(75.9%).OHWIs were more common in the right upper extremity(55.3%)and comprised different types of injuries,such as contusion(42.1%),laceration(27.9%),fracture(18.7%),and crush injury(15.6%).They primarily affected the phalanges(95.2%),especially those of the first finger(25.7%).The CAs showed associations between the injured anatomical area and the worker’s job that differed in men and women(explained variance>90%).CONCLUSION One out of five workers who suffered occupational accidents in Cundinamarca,Columbia had an OHWI,affecting mainly males employed in mining.This occupational profile is likely to lead to prolonged rehabilitation,and permanent functional limitations.Our results might be useful for adjusting preventive measures in cluster risk groups.
基金Supported by Ministry of Science and Higher Education of the Russian Federation,No.075-15-2022-301.
文摘BACKGROUND Previous studies in the pre-biological era showed an association of wrist inflammation in juvenile idiopathic arthritis(JIA)with progressive disease course,polyarticular involvement and failure of methotrexate treatment.AIM To describe features of JIA,associated with wrist arthritis.METHODS Data from about 753 JIA patients were included in this retrospective cohort study.The clinical and laboratory features of patients with and without wrist involvement were analyzed.RESULTS Wrist involvement was found in oligoarthritis(5.8%),RF(−)/RF(+)polyarthritis(44.9%/15.0%),enthesitis-related arthritis(17.7%),and systemic(58.6%)JIA categories.Unilateral wrist involvement was typical for oligoarthritis patients,bilateral involvement was either equal to that of unilateral involvement or was more frequent in other categories.Wrist arthritis was found to be associated with female sex,a low incidence of uveitis,and more indications of systemic inflammation,including elevated levels of C-reactive protein,erythrocyte sedimentation rate,and platelets,as well as involvement of the cervical spine,temporomandibular,shoulder,elbow,metacarpophalangeal,proximal interphalangeal,distal interphalangeal,hip,ankle,and tarsus arthritis.The number of patients with hip osteoarthritis and hip replacement was also higher.Wrist arthritis was associated with a lower probability of achieving remission[hazard ratio(HR)=1.3(95%CI:1.0-1.7),P=0.055],and a higher probability of being treated with biologics[HR=1.7(95%CI:1.3-2.10,P=0.00009)].CONCLUSION Wrist arthritis in JIA patients is a marker of a severe disease course,characterized by more intensive inflammation,unfavorable outcomes,and.requiring more intensive treatment with early administration of biologics.Close monitoring of wrist inflammation with ultrasound and MR assessment with early biological treatment might improve the outcomes.
文摘Based on an analysis of the relative shaft-to-hole position and attiude errors, as well as of the mechanics and Kinematics in the process of automatic assembly of industrial robots, the paper studies the principle of construction of dynamic wrists. Type I-3 and Ⅱ-6 dynamic compliant wrists have been designed and made. Prblems in the production of compliant elements and the connection between compliant elements and wrists were also solved. A study on the results of tests of the function of two kinds of dynamic compliant wrists shows that the dynamic compliant wrist's compliancy function can be improved by adding metallic materials having higher longitudinal and transverse rigidity into the softer elstomer. And the design Principle is proved to be feasible and practicable. It can be expected that the use of dynamic compliant wrist will greatly lower the technical requirements of the shaft-hole assembly and the requirements in the resetting accuracy.
文摘In rheumatoid arthritis the small joints of the feet and hands are the first targets of the autoimmune process. In about one half of the patient the wrist is involved in the first stages of the disease(two years) increasing up to nearly 90 percent after a decade often including both sides. Osteoarthritis of the wrist is one of the most common conditions encountered by hand surgeons. One aim of all treatment options is to achieve the best possible hand function without pain. If conservative treatment fails, operative treatment is necessary. Choice of surgical treatment depends on the soft tissue and bone situation. Techniques can be differentiated by joint preservation or joint replacement. The first include radio-synoviorthesis, synovectomy and tendon repair, the latter resection-arthroplasty, total joint arthroplasty and arthrodesis. In this paper arthrodesis of the wrist as one treatment option is reviewed.
基金Beijing Jishuitan Hospital Nova Program Funding[XKXX201617]。
文摘Objective The objective of this report was to demonstrate the clinical application of free flow-through anterolateral thigh flaps for the treatment of high-tension electrical wrist burns.Methods We collected the data of 8 patients with high-tension electrical wrist burns admitted to Beijing Jishuitan Hospital from January 2014 to December 2018.The clinical and pathological data were extracted from electronic hospital medical records.We obtained follow-up information through clinic visits.Results The injury sites for all 8 patients were the wrists,specifically 5 right and 3 left wrists,all of which were on the flexor side.Five patients had ulnar artery embolism necrosis and patency,with injury to the radial artery.Two patients had ulnar and radial arterial embolization and necrosis.The last patient had ulnar arterial embolization and necrosis with a normal radial artery.After debridement,the wound area ranged from 12 cm×9 cm to 25 cm×16 cm.The diagnoses for the eight patients were type II to type III high-tension electrical wrist burns.Free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)were used to repair the wounds.The prognosis for all patients was good after six months to one year of follow-up.Conclusion Treating wrist types II and III high-tension electrical burns is still challenging in clinical practice.The use of free flow-through anterolateral thigh flaps(combined with great saphenous vein transplantation if necessary)to repair the wound and to restore the blood supply for the hand at the same time is a good choice for treating severe wrist electrical burns.
文摘BACKGROUND Multiple rice bodies in the wrist is a rare disorder that requires surgery,and there are still many uncertainties regarding its diagnosis and treatment.CASE SUMMARY We described a rare case of chronic idiopathic tenosynovitis with rice bodies of the wrist in a 71-year-old man and reviewed similar topics in the literature.A total of 43 articles and 61 cases were included in the literature review.Our case had a usual presentation:it was similar to those in the literature.The affected population was mainly older adults,with an average age of 59.43(range,3 to 90)years.The male-to-female ratio was 1.54:1(37/24).Most of them showed limited swelling and pain,only 23.0%had carpal tunnel symptoms,and the average disease duration was 18.03(0.5-60)mo.Wrist flexor tendon sheath involvement was the most common(95.1%,58/61),and only 3 cases had extensor tendon sheath involvement.The main causes were tuberculosis(34.4%,21/61),nontuberculous mycobacteria(24.6%,15/61),idiopathic tenosynovitis(31.1%,19/61),and others(9.84%,6/61).There were 10 patients with recurrences;in 6 of them,were due to non-tuberculous mycobacterial infections.CONCLUSION We reported a case of wrist idiopathic tenosynovitis with rice body formation,and established a clinical management algorithm for wrist tenosynovitis with rice bodies,which can provide some reference for our clinical diagnosis and treatment.The symptoms of rice-body bursitis of the wrist are insidious,nonspecific,and difficult to identify.The aetiology is mainly idiopathic tenosynovitis and mycobacterial(tuberculosis or non-tuberculous)infections;the latter are difficult to treat and require long-duration systemic combination antibiotic therapies.Therefore,before a diagnosis of idiopathic tenosynovitis is made,we must exclude other causes,especially mycobacterial infections.
文摘BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.
文摘Wrist cracks are the most common sort of cracks with an excessive occurrence rate.For the routine detection of wrist cracks,conventional radiography(X-ray medical imaging)is used but periodically issues are presented by crack depiction.Wrist cracks often appear in the human arbitrary bone due to accidental injuries such as slipping.Indeed,many hospitals lack experienced clinicians to diagnose wrist cracks.Therefore,an automated system is required to reduce the burden on clinicians and identify cracks.In this study,we have designed a novel residual network-based convolutional neural network(CNN)for the crack detection of the wrist.For the classification of wrist cracks medical imaging,the diagnostics accuracy of the RN-21CNN model is compared with four well-known transfer learning(TL)models such as Inception V3,Vgg16,ResNet-50,and Vgg19,to assist the medical imaging technologist in identifying the cracks that occur due to wrist fractures.The RN-21CNN model achieved an accuracy of 0.97 which is much better than its competitor`s approaches.The results reveal that implementing a correct generalization that a computer-aided recognition system precisely designed for the assistance of clinician would limit the number of incorrect diagnoses and also saves a lot of time.
基金National Hi-tech Research and Development Program of China(863 Program,No.2001AA42330).
文摘Negative step response experimental method is used in wrist force sensor＇s dynamic performance calibration. The exciting manner of negative step response method is the same as wrist force sensor＇s load in working. This experimental method needn＇t special experiment equipments. Experiment＇s dynamic repeatability is good. So wrist force sensor＇s dynamic performance is suitable to be calibrated by negative step response method. A new correlation wavelet transfer method is studied. By wavelet transfer method, the signal is decomposed into two dimensional spaces of time-frequency. So the problem of negative step exciting energy concentrating in the low frequency band is solved. Correlation wavelet transfer doesn＇t require that wavelet primary function be orthogonal and needn＇t wavelet reconstruction. So analyzing efficiency is high. An experimental bench is designed and manufactured to load the wrist force sensor orthogonal excitation force/moment. A piezoelectric force sensor is used to setup soft trigger and calculate the value of negative step excitation. A wrist force sensor is calibrated. The pulse response function is calculated after negative step excitation and step response have been transformed to positive step excitation and step response. The pulse response function is transferred to frequency response function. The wrist force sensor＇s dynamic characteristics are identified by the frequency response function.
文摘BACKGROUND Acute hand and wrist injuries are common and may lead to long-term disability if not managed adequately.Claims for negligence have been increasing in medical practice over the past few decades,with hand and wrist injuries and their treatment representing a significant percentage of orthopedic surgery lawsuits.There is no available literature regarding medical malpractice claims in hand and wrist injuries and surgery in Greece.AIM To identify claims related to hand and wrist trauma and surgery and to define the reasons of successful litigations.METHODS We performed a retrospective study of all legal claims of negligence for hand and upper extremity surgery that went to a trial,attributed to all surgical specialties,in Greece for a 20-year period.Data was further analyzed to identify claims related to hand and wrist trauma and surgery.RESULTS There were six malpractice claims related to hand and wrist trauma that ended in a trial.A missed diagnosis,which resulted in failure of initial management of the injury,was the main reason for a claim.Three of the six cases resulted in complete or partial loss of a finger.Two cases are still open,requiring an expert witness’s report,two cases were closed in favor of the defendant,and two cases were closed in favor of the plaintiff with a mean compensation of€2000(€1000-€3000).CONCLUSION Missed diagnosis was the main reason for a malpractice claim.Better understanding of factors leading to successful claims will help surgeons improve their practice to minimize legal implications and litigation.
文摘The transfer matrix of wrist force sensor is important for decoupling theoutput signals and enhancing the precision of wrist force sensor.This paper solves thetransfer matrix from the realization of optimal approximation of polynomial.First,thegeneral transfer matrix algorithm in the sense of L^2 and two kinds of modified algorithmare proposed.Then,starting from uniform approximation,the optimal transfer matrixalgorithm is offered and solved by the use of linear programming.The results of experi-ment and computation prove that these algorithms are effective.
基金Supported by Aix-Marseille University and APHM(Assistance Publique Hopitaux de Marseille),No.CNRS(UMR#7339)
文摘AIM: To quantify the wrist cartilage cross-sectional area in humans from a 3D magnetic resonance imaging(MRI) dataset and to assess the corresponding reproducibility. METHODS: The study was conducted in 14 healthy volunteers(6 females and 8 males) between 30 and 58 years old and devoid of articular pain. Subjectswere asked to lie down in the supine position with the right hand positioned above the pelvic region on top of a home-built rigid platform attached to the scanner bed. The wrist was wrapped with a flexible surface coil. MRI investigations were performed at 3T(Verio-Siemens) using volume interpolated breath hold examination(VIBE) and dual echo steady state(DESS) MRI sequences. Cartilage cross sectional area(CSA) was measured on a slice of interest selected from a 3D dataset of the entire carpus and metacarpalphalangeal areas on the basis of anatomical criteria using conventional image processing radiology software. Cartilage cross-sectional areas between opposite bones in the carpal region were manually selected and quantified using a thresholding method.RESULTS: Cartilage CSA measurements performed on a selected predefined slice were 292.4 ± 39 mm2 using the VIBE sequence and slightly lower, 270.4 ± 50.6 mm2, with the DESS sequence. The inter(14.1%) and intra(2.4%) subject variability was similar for both MRI methods. The coefficients of variation computed for the repeated measurements were also comparable for the VIBE(2.4%) and the DESS(4.8%) sequences. The carpus length averaged over the group was 37.5 ± 2.8 mm with a 7.45% between-subjects coefficient of variation. Of note, wrist cartilage CSA measured with either the VIBE or the DESS sequences was linearly related to the carpal bone length. The variability between subjects was significantly reduced to 8.4% when the CSA was normalized with respect to the carpal bone length.CONCLUSION: The ratio between wrist cartilage CSA and carpal bone length is a highly reproducible standardized measurement which normalizes the natural diversity between individuals.
文摘Introduction and Aims—The Growth stage of a patient can have considerable influence on diagnosis, treatment goals, timing and planning and the eventual outcome of orthodontic/orthopedic treatment. The purpose of this study was to analyze associations between the cervical vertebrae maturation score (CVMS) and skeletal maturation index (SMI). The second objective was to determine the reproducibility of the measurements on lateral cephalograms and hand-wrist radiographs. Materials and Methods—Lateral cephalometric and left hand-wrist radiographs of 92 untreated subjects (44 females and 48 males) aged from 8 to 17 years were obtained from the files of the Columbia University, Division of Orthodontics and measured for growth stage using cervical vertebrae and hand-wrist methods. Results—A high correlation was revealed between the hand-wrist and cervical vertebrae measurements. The Spearman’s rho correlation coefficient was 0.925 and significant at the 0.01 level. The correlation between hand-wrist and age (0.665, p < 0.01) was slightly greater than that of the CVMS (0.611, p < 0.01). Intra rater reliability was high. When the three categorically modified methods of the Fishman’s 11 skeletal maturation stages in hand and wrist analysis were used to compare with CVMS, methods 2 and 3 were both statistically significantly different according to the Wilcoxon signed ranks test and the Sign test at a significance level of less than 0.05. However, for method 1, the tests showed probability scores of 0.028 and 0.151, respectively, showing no significant difference at the 0.01 level in the Wilcoxon Signed Ranks Test, and no significant difference in the 0.01 and 0.05 level in the Signed Test. Conclusions—The Fishman’s hand and wrist skeletal maturation index and Bacetti’s cervical vertebrae maturation stages are both useful tools in evaluating growth stages. Fishman’s hand-wrist method is slightly more accurate.
文摘In wrist pathology, there is a need to establish the normal range of radiographic measurement parameters. Previous study showed that the contralateral wrist might not be valid as a reference for all parameters. There is a lack of literature describing the normal range of wrist radiographic parameters in literature. As a result, a retrospective study was carried out. Patients who underwent standard wrist x-rays during the period February 2012 to February 2013 (one single year) were retrospectively reviewed. 71 patients were included. Scapholunate angle was 54.7° (±6.5°). Scapholunate interval was 2.0 mm (±0.4 mm). Ulnar variance was +1.0 mm (±1.8 mm). Carpal height was 31.8 mm (±3.0 mm). Radial inclination was 25.1° (±2.1°). All 71 patients had 1 sesamoid bone at first metacarpal. 16.9% (12 out of 71) patients had positive cortical ring signs. All these parameters are valuable clinically, especially in monitoring of the wrist disease progression, in the design of wrist implants and for future clinical research.
