Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in a...Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.展开更多
Chondrosarcoma (CS) is a malignant neoplasm of mesenchymal origin characterized by the formation of cartilaginous matrix by neoplastic cells. It is very variable in presentation, clinical, genetic and anatomo-patholog...Chondrosarcoma (CS) is a malignant neoplasm of mesenchymal origin characterized by the formation of cartilaginous matrix by neoplastic cells. It is very variable in presentation, clinical, genetic and anatomo-pathological features. CS is more often found in the pelvis and the proximal long bones (femur, humerus). Localization to the small bones of the hand is very rare and it represents a diagnostic and therapeutic challenge. CSs are malignancies resistant to both radiation and chemotherapy . Surgical treatment is the only mean available. As opposed to CSs located elsewhere, CS of the hand is characterized by local recurrence and very low metastatic potential. In order to definitely set a diagnosis of chondrosarcoma in this region, comparison of histological and radiological findings is paramount. The principle goal of surgery shall be minimizing functional impairment. This provides the rationale for performing curettage, local adjuvant therapy and bone grafting in low-grade lesions.展开更多
Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate...Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.展开更多
AIM To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures. METHODS This review highlights technical considerations lear...AIM To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures. METHODS This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically. RESULTS Twenty-six of the 382 internally fixed distal radial fractures at our unit(6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Postoperatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21o, 4.3o and-1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation CONCLUSION The use of a rim plate enables control of challenging fardistal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.展开更多
AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel releas...AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.展开更多
文摘Triangular fibrocartilage complex injuries are common in amateur and professional sports.These injuries are mainly caused by acute or chronic repetitive axial loads on the wrist,particularly on the ulnar side and in association with rotations or radial/ulnar deviations.In order to treat professional athletes,a detailed specific knowledge of the pathology is needed.Moreover,the clinician should fully understand the specific and unique environment and needs of the athletes,their priorities and goals,the type of sport,the time of the season,and the position played.An early diagnosis and appropriate management with the quickest possible recovery time are the uppermost goals for both the athlete and the surgeon.A compromise between conservative vs surgical indications,athletes’needs and expectations,and financial implications should be achieved.Arthroscopic procedures should be timely planned when indicated as they could allow early diagnosis and treatment at the same time.Conservative measures are often used as first line treatment when possible.Peripheral lesions are treated by arthroscopic repair,whilst central lesions are treated by arthroscopic debridement.Further procedures(such as the Wafer procedure,ulnar osteotomies,etc.)have specific indications and great implications with regard to rehabilitation.
文摘Chondrosarcoma (CS) is a malignant neoplasm of mesenchymal origin characterized by the formation of cartilaginous matrix by neoplastic cells. It is very variable in presentation, clinical, genetic and anatomo-pathological features. CS is more often found in the pelvis and the proximal long bones (femur, humerus). Localization to the small bones of the hand is very rare and it represents a diagnostic and therapeutic challenge. CSs are malignancies resistant to both radiation and chemotherapy . Surgical treatment is the only mean available. As opposed to CSs located elsewhere, CS of the hand is characterized by local recurrence and very low metastatic potential. In order to definitely set a diagnosis of chondrosarcoma in this region, comparison of histological and radiological findings is paramount. The principle goal of surgery shall be minimizing functional impairment. This provides the rationale for performing curettage, local adjuvant therapy and bone grafting in low-grade lesions.
文摘Triggering,locking,clicking,and crepitus of the fingers are common symptoms patients present with.Even though crepitus and triggering can occur as part of the same underlying diagnosis,it is important to differentiate between them,as they usually indicate different possible diagnoses.The differential diagnoses that should be considered include trigger finger,metacarpophalangeal joint(MCPJ)arthritis,fractures or dislocations,extensor digitorum communis subluxation or dislocation,locked MCPJ,avascular necrosis of the metacarpal head,and Dupuytren’s disease.A thorough clinical examination with appropriate special investigations can permit the clinician to make the correct diagnosis.Appropriate management of a confirmed diagnosis is successful in providing symptomatic improvement.
文摘AIM To determine technical considerations and radiographic outcomes of the Synthes volar rim distal radius plate to treat complex intra-articular fractures. METHODS This review highlights technical considerations learnt using this implant since it was introduced in a major trauma unit in November 2011, including anatomical reduction and whether this was maintained radiographically. RESULTS Twenty-six of the 382 internally fixed distal radial fractures at our unit(6.8%) were deemed to require this plate in order to achieve optimal fracture fixation between November 2011 and May 2014. A further dorsal and/or radial plate was necessary in 35% and variable angle screws were used in 54% of cases. Postoperatively, mean radial height, inclination, volar tilt and ulnar variance restored were 11.7 mm, 21o, 4.3o and-1.2 mm respectively. There were no cases of non-union or flexor/extensor tendon rupture; one case of loss of fracture reduction. Overall incidence of plate removal was 15% with one plate removed for flexor and one for extensor tendon irritation CONCLUSION The use of a rim plate enables control of challenging fardistal fracture patterns. However, additional plates were required to improve and maintain reduction. Variable angle screws were necessary in half the cases to avoid intra-articular screw penetration. If used judiciously, this implant can achieve stable fixation despite the complexity of the fracture pattern.
文摘AIM: To determine whether patients taking aspirin during carpal tunnel release had an increase of complications.METHODS: Between January 2008 and January 2010, 150 patients underwent standard open carpal tunnel release(CTR) under intravenous regional anaesthesia. They were divided into three groups: groups 1 and 2 were made of 50 patients each, on aspirin 100 mg/d for at least a year. In group 1 the aspirin was never stopped. In group 2 it was stopped at least 5 d before surgery and resumed 3 d after. Group 3 acted as a control, with 50 patients who did not take aspirin. The incidence of clinically significant peror post-operative complications was recorded and divided into local and cardio-cerebro-vascular complications. Local complications were then divided into minor and major according to Page and Stern. Local haematomas were assessed at 2 d(before resuming aspirin in group 2) and 14 d(after resuming aspirin in group 2) postoperatively. Patients were reviewed at 2, 14 and 90 d after surgery.RESULTS: There was no significant difference in the incidence of complications in the three groups. A total of 3 complications(2 major and 1 minor) and 27 visible haematomas were recorded. Two major complications were observed respectively in group 1(non stop aspirin) and in group 3(never antiaggregated). The minor complication, observed in one patient of group 2(stop aspirin), consisted of a wound dehiscence, which only led to delayed healing. All haematomas were observed in the first 48 h, no haematoma lasted for more than 2 wk and all resolved spontaneously. A major haematoma(score > 20 cm2) was observed in 8 patients. A minor haematoma(score < 20 cm2) was recorded in 19 patients. All patients at 90 d after surgery were satisfied with the result in terms of relief of their preoperative symptoms. Major and minor haematomas did not impair hand function or require any specific therapy.CONCLUSION: Our study demonstrates that continuation of aspirin did not increase the risk of complications. It is unnecessary to stop aspirin before CTR with good surgical techniques.
