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Study Design
Case report.Introduction
Development of extensor tendon adhesions is a common complication after intra-articular metacarpal head fracture. Whenever these adhesions cannot be mobilized by rehabilitation, tenolysis should be considered. However, the decision for tenolysis is often delayed. When the rehabilitation program comes to a plateau and clinical examination may not be sufficient to find out the cause, dynamic ultrasound (US) can show where the gliding mechanism is disrupted and help clinicians to give an accurate decision for determining the next steps.Purpose of the Study
To determine the role of dynamic US during hand rehabilitation.Methods
A 22-year-old woman presented with a fifth metacarpal intra-articular head fracture. Ten days after the surgery (open reduction and internal fixation) the hand rehabilitation program was commenced. After the third week, the metacarpophalangeal (MP) joint range of motion (ROM) gradually diminished. Dynamic US near the level of fifth MP joint revealed diminished extensor tendon excursion and capsular thickening.Results
Considering physical and sonographic findings, surgical tenolysis and capsular release was planned. After surgery, the DIP, PIP and MP joints reached full passive ROM.Conclusion(s)
Ultrasound is a quick and practical way to diagnose tendon adhesions. With this report, the authors suggest that clinicians may use dynamic US, especially in times when the patient comes to plateau during hand rehabilitation.Level of Evidence
IV. 相似文献3.
Purpose
Reduction and fixation in femoral neck fracture in young patients have a problem of nonunion requiring additional procedure like valgus osteotomy but fixation devices are technically difficult for inexperienced surgeons. We aims to assess the results of valgus osteotomy in femoral neck fracture in our setup.Methods
We report a series of 20 patients of higher Pauwel's angled fracture of femoral neck fracture presenting late wherein for valgus osteotomy was added to reduction fixation secured with a commonly available 135° dynamic hip screw and plate.Results
Femoral neck fractures united in 16 patients (80%). Excellent to good results (Harris hip score >80) were seen in 70% patients. Angle of correction of preoperative Pauwels has been changed from 68.3 to 34.3.Conclusion
135° dynamic hip screw and plate provides rigid internal fixation after valgus osteotomy and being a more familiar fixation device simplifies the procedure with good results. 相似文献4.
Study Design
Case series.Introduction
Upper extremity (UE) trauma and subsequent immobilization affects functional performance.Purpose of the Study
Determine the usefulness and feasibility of unilateral hand training (UHT) on improving functional performance in patients with UE trauma.Methods
Nine participants received UHT within 10 days of immobilization. Functional performance, dexterity, grip, and pinch strength were measured at initial and 4-week visits. Qualitative interviews were coded to develop themes.Results
All Jebsen-Taylor hand function test subtests improved from pretest to post-test. Disabilities of the Arm, Shoulder and Hand scores of all 9 participants improved. Functional performance was more impaired for participants with dominant UE injury. Four themes emerged: participants were forced to alter or avoid most daily activities, had an increased dependency on others, took longer to perform activities, and felt UHT decreased the impact of UE trauma on function.Discussion
Functional performance was impaired for all participants. Participants believed that UHT was useful and contributed to improved function.Conclusion
This case series tracked a comprehensive intervention based on a holistic activities of daily living framework that considered the nuances of individual complexities of immobilization following hand trauma. Knowledge from this study supports an early intervention like UHT to educate clients on effective strategies to improve immediate activities of daily living functioning and potentially prevent longer term impairments. 相似文献5.
Study Design
Two-group randomized controlled trial.Introduction
Upper limb orthoses worn during functional tasks are commonly used in pediatric neurologic rehabilitation, despite a paucity of high-level evidence.Purpose of the Study
The purpose of this study was to investigate if a customized functional wrist orthosis, when placed on the limb, leads to an immediate improvement in hand function for children with cerebral palsy or brain injury.Methods
A 2-group randomized controlled trial involving 30 children was conducted. Participants were randomized to either receive a customized functional wrist orthosis (experimental, n = 15) or not receive an orthosis (control, n = 15). The box and blocks test was administered at baseline and repeated 1 hour after experimental intervention, with the orthosis on if randomized to the orthotic group.Results
After intervention, there were no significant differences on the box and blocks test between the orthotic group (mean, 10.13; standard deviation, 11.476) and the no orthotic group (mean, 14.07; standard deviation, 11.106; t[28], ?0.954; P = .348; and 95% confidence interval, ?12.380 to 4.513).Discussion
In contrast to the findings of previous studies, our results suggest that a functional wrist orthosis, when supporting the joint in a ‘typical’ position, may not lead to an immediate improvement in hand function.Conclusions
Wearing a functional wrist orthosis did not lead to an immediate improvement in the ability of children with cerebral palsy or brain injury to grasp and release. Further research is needed combining upper limb orthoses with task-specific training and measuring outcomes over the medium to long term. 相似文献6.
Nikolaus Johannes Wachter Martin Mentzel Gert D. Krischak Joachim Gülke 《Journal of hand therapy》2019,32(1):64-70
Study Design
A within-subject research design was used in this study. The difference of the range of motion (ROM) with and without ulnar nerve block was analyzed.Introduction
For the clinical evaluation of the functional effects of ulnar nerve palsy at the hand the relevance of clinical tests is in discussion.Purpose of the Study
The aim of the study was to evaluate the predictive value of 2 clinical tests for a simulated ulnar nerve lesion by motion analysis with a sensor glove.Methods
In 28 healthy subjects, dynamic measurements of the finger joints were performed by a sensor glove with and without ulnar nerve block at the wrist. In the 0° metacarpophalangeal (MCP) stabilization test, the subjects were asked to stabilize the MCP joints actively in 0° while moving the interphalangeal joints, whereas at the 90° MCP stabilization test, the subjects stabilized the MCP joints actively in the 90° position.Results
In the 0° MCP stabilization test, no remarkable changes of the ROM were found at the MCP joints; at the proximal interphalangeal joints 2-5, the ROM decreased with ulnar nerve block, significantly at the index, middle, and ring fingers (P < .05). In the 90° MCP stabilization test, the average ROM of the MCP joints 2-5 significantly increased with ulnar nerve block (P < .05), whereas at the PIP joints, the average ROM decreased (P < .05).Discussion
The 90° MCP stabilization test had a high predictive value for the discrimination between healthy subjects and subjects with a simulated peripheral ulnar nerve lesion.Conclusions
The results could be relevant for the determination of the functional effect of ulnar nerve palsy and the quantification of clawing in hand rehabilitation.Level of Evidence
II. 相似文献7.
Study Design
Case series.Introduction
A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies. However, psychosocial reactions for individuals with upper extremity (UE) limb salvage are understudied in the literature.Purpose of the Study
The purpose of this study was to explore the process of psychosocial adaptation for 3 trauma cases after UE limb salvage.Methods
The Reactions to Impairment and Disability Inventory was used to assess psychosocial adaptation. Physical function outcomes (pain, range of motion, edema, sensation, and dexterity) are presented. The Disabilities of the Arm, Shoulder, and Hand measure was used to assess perceived disability. Medical and rehabilitation history are discussed for each case, in order to provide in-depth understanding of the impact of these injuries.Results
Reactions to injury varied across the cases; however, outcomes suggest that psychosocial adaptation may be influenced by the experience of pain, the ability to participate in valued roles and activities, and having a supportive social network.Discussion
For this population, therapists may consider emphasizing pain management, focusing on client-centered goals and interventions, and facilitating peer support. Providers should closely monitor patients for signs of poor adaptation, such as hand-hiding behaviors.Conclusions
This study is among the first to examine psychological outcomes for the UE limb salvage population. Future research would be beneficial to provide deeper understanding of the psychosocial challenges for these individuals. 相似文献8.
Trine G. Eskesen Josefine S. Baekgaard Thomas Peponis Jae Moo Lee Noelle Saillant Haytham M.A. Kaafarani Peter J. Fagenholz David R. King Marc de Moya George C. Velmahos D. Dante Yeh 《American journal of surgery》2019,217(4):648-652
Background
We aimed to determine the incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault.Methods
The ACS National Trauma Data Bank (NTDB) 2012 Research Data Set was used to identify victims of blunt assault using the ICD-9 E-codes 960.0, 968.2, 973. ICD-9 codes 805.00, 839.00, 806.00, 952.00 identified cervical vertebral fractures/dislocations and CSCI. Multivariable analyses were performed to identify independent predictors of CSCI.Results
14,835 (2%) out of 833,311 NTDB cases were blunt assault victims and thus included. 217 (1%) had cervical vertebral fracture/dislocation without CSCI; 57 (0.4%) had CSCI. Age ≥55 years was independently predictive of CSCI; assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI. 25 (0.02%) patients with CSCI underwent cervical spinal fusion.Conclusions
CSCI is rare after blunt assault. While the odds of CSCI increase with age, facial fracture or intracranial injury predicts the absence of CSCI.Summary
The incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault was investigated. 14,835 blunt assault victims were identified; 217 had cervical vertebral fracture/dislocation without CSCI; 57 had CSCI. Age ≥55 years was found to independently predict CSCI, while assault by striking/thrown object, facial fracture, and intracranial injury predicted the absence of CSCI. 相似文献9.
Study Design
Clinical measurement (reliability and validity) study.Introduction
Forearm supination is important in many daily activities and is thus measured by therapists and researchers usually with a universal goniometer. DrGoniometer, a SmartPhone application, has been validated for other joint angles in the body.Purpose of the Study
To establish the reliability and validity of DrGoniometer (CDM S.r.L, Cagliari, Italy) for measuring forearm supination in healthy populations and those with forearm fractures.Methods
Participants had sustained a distal radius fracture that was treated non-surgically. Forearm supination of the participant’s fractured (n = 30) and healthy forearm (n = 30) was measured using DrGoniometer and the universal goniometer by two assessors. The assessors were blinded to each other’s measurements and their own previous measurements. Reliability was established by calculating Intra-class Correlation Coefficients, standard error of measurement and minimal detectable change. The validity of DrGoniometer was established against the universal goniometer using Pearson’s correlation co-efficient.Results
Intra-rater reliability of both DrGoniometer and the universal goniometer was high for both fractured and healthy forearms (ICCs ranged from 0.74-0.88). Inter-rater reliability of both DrGoniometer and the universal goniometer was also high in the fractured forearm group (0.76 and 0.72 respectively), but low in the healthy forearm group (0.34 and 0.42 respectively). Correlation between the tools was excellent across the fractured and healthy forearm groups (0.94 and 0.93 respectively).Discussion
Both goniometers demonstrated good-to-excellent intrarater and iner-rater reliability except in the healthy forearm group where both goniometers demonstrated poor inter-rater reliability which could be due to assessor instructions. The speed the photo can be taken and the digital record obtained are valuable aspects of DrGoniometer.Conclusion
DrGoniometer is a valid, alternate tool for measuring forearm supination. 相似文献10.
Areg Grigorian Jeffrey Milliken Joshua K. Livingston Dean Spencer Viktor Gabriel Sebastian D. Schubl Allen Kong Cristobal Barrios Victor Joe Jeffry Nahmias 《American journal of surgery》2019,217(4):639-642
Background
Blunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI.Methods
We queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients.Results
BCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR?=?5.52, CI?=?5.32–5.73, p?<?0.001) compared to TAI (OR?=?4.82, CI?=?4.50–5.17, p?<?0.001). However, the strongest independent predictor was hemopneumothorax (OR?=?9.53, CI?=?7.80–11.65, p?<?0.001) followed by SF and esophageal injury (OR?=?5.47, CI?=?4.05–7.40, p?<?0.001).Conclusion
SF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI.Summary
Using the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor. 相似文献11.
Joseph A. Gil Kerry Ebert Keri Blanchard Avi D. Goodman Joseph J. Crisco Julia A. Katarincic 《Journal of hand therapy》2019,32(1):80-85
Study Design
Basic research (biomechanics).Introduction
The high degree of motion that occurs at the thumb metacarpophalangeal (MCP) joint must be taken into account when immobilizing a partially torn or repaired thumb ulnar collateral ligament.Purpose of the Study
To determine the efficacy of a radial-based thumb MCP-stabilizing orthosis in resisting abduction across the thumb ulnar collateral ligament.Methods
Ten fresh cadaveric hands were mounted to a custom board. An anteroposterior radiograph of the thumb was obtained with a 2 N preload valgus force applied to the thumb, and the angle between the Kirschner wires was measured as a baseline. Subsequently, 20, 40, 60, 80, and 100 N valgus forces were applied 15 mm distal to the MCP joint. Anteroposterior radiographs of the thumb were obtained after each force was applied. The angle of displacement between the wires was measured and compared with the baseline angle. The angles were measured with an imaging processing tool. A custom radial-based thumb MCP-stabilizing orthosis was fashioned for each cadaveric thumb by a certified hand therapist. The aforementioned loading protocol was then repeated.Results
The radial-based thumb MCP-stabilizing orthosis significantly reduced mean abduction angles at each applied load.Discussion
We found that our orthosis, despite being hand-based and leaving the thumb IP and CMC joints free, significantly reduced mean abduction angles at each applied load.Conclusions
This investigation provides objective evidence that our radial-based thumb MCP-stabilizing orthosis effectively reduces the degree of abduction that occurs at the thumb MCP joint up to at least 100 N.Level of Evidence
n/a (cadaveric). 相似文献12.
Tomoko Mizota Nicholas E. Anton Dimitrios Stefanidis 《American journal of surgery》2019,217(2):222-227
Background
This study aimed to identify differences in pattern recognition skill among individuals with varying surgical experience.Methods
Participants reviewed laparoscopic cholecystectomy videos of various difficulty, and paused them when the cystic duct or artery was identified to outline each structure on the monitor. Time taken to identify each structure, accuracy and work load, which was assessed using the NASA-Task Load Index (TLX), were compared among the three groups.Results
Ten students, ten residents and eight attendings participated in the study. Attendings identified the cystic duct and artery significantly faster and more accurately than students, and identified the cystic artery faster than residents. The NASA-TLX score of attendings was significantly lower than that of students and residents.Conclusions
Attendings identified anatomical structures faster, more accurately, and with less effort than students or residents. This platform may be valuable for the assessment and teaching of pattern recognition skill to novice surgeons.Short summary
Accurate anatomical recognition is paramount to proceeding safely in surgery. The assessment platform used in this study differentiated recognition skill among individuals with varing surgical experience. 相似文献13.
Elise A. Dasinger Westyn Branch-Elliman Steven D. Pizer Hassen Abdulkerim Amy K. Rosen Martin P. Charns Mary T. Hawn Kamal M.F. Itani Hillary J. Mull 《American journal of surgery》2019,217(4):605-612
Background
Opioid-related adverse drug events are common following inpatient surgical procedures. Little is known about opioid prescribing after outpatient surgical procedures and if opioid use is associated with short term risks of outpatient surgical adverse events (AEs).Methods
VA Corporate Data Warehouse was used to identify opioid use within 48?h for FY2012-14 chart-reviewed cases from a larger VA study of AEs in outpatient surgeries. We estimated a multilevel logistic regression model to determine the effect of opioid exposure on risk of AEs between 2 and 30 days postoperatively.Results
Of the 1730 outpatient surgical cases, 628 (36%) had postoperative opioid use and 12% had an AE. Opioid use following outpatient surgery was not significantly associated with higher surgical AE rates after controlling for relevant covariates (OR?=?1.1 95% CI 0.79–1.54). Only procedure RVUs were associated with higher odds of postoperative AEs.Conclusions
Postoperative opioid use following outpatient surgery is not a significant driver of postoperative AEs. 相似文献14.
Osman Emre Aycan Sami Sökücü Devrim Özer Engin Çetinkaya Yavuz Arıkan Yavuz Selim Kabukçuoğlu 《Acta orthopaedica et traumatologica turcica》2019,53(1):30-34
Objective
The aim of this study was to discuss the diagnosis and surgical management and their results according to stage of primary bone tumors at ulna and to share our experience on this exceptional location for bone tumors.Methods
We have retrospectively reviewed our clinics database and identified 23 cases (14 males and 9 females, mean age was 28.9 (range 4–77)) with primary bone tumors and tumor like lesion involvement of ulna. The patients were evaluated according to complaints, type and grade of tumor, treatment, recurrence and functional status.Results
The most common first referral complaint was constrictive pain in 52.1% of the cases, benign tumors and tumor like lesions of the bone constituted 73.9% whereas malignant bone tumors were 26.1%, 39.1% of the lesions were located in distal end of ulna and the mean follow up was 33.8 months (range 8–172 months). Local recurrence has unexpectedly occurred in 3 benign lesions (13.1%).Conclusion
Benign bone lesions tend to involve distal and proximal ends, malign bone lesions involve diaphysis mostly. Both benign and malignant diaphyseal lesions of the ulna have better postoperative results regarding the lesions at both ends of ulna. One should also take care of recurrences even after a decade from the primary surgery.Level of evidence
Level IV, Therapeutic study 相似文献15.
Byron D. Hughes Eric Sieloff Hemalkumar B. Mehta Anthony J. Senagore 《American journal of surgery》2019,217(3):534-538
Background
In 2008, 2005–2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts.Methods
Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes. Ninety percent of our 409,230 patients matched into a procedure group and adverse event rates were analyzed for each.Results
Ten procedure groups accounted for 80% of adverse events. Colectomy ranked the highest for adverse events (34%), readmissions (27%) and mortality rates (45.8%). For outpatient cholecystectomy, the relative percent point difference for adverse events has increased by 224% since 2005.Conclusion
Refocusing on colectomy and outpatient cholecystectomy represent current priorities in general surgery. 相似文献16.
Study Design
Prospective cohort.Introduction
Clinical studies that evaluate the correlation between associated lesions of the triangular fibrocartilage complex (TFCC) and outcome of distal radial fractures expressed with the patient-rated disability are missing.Purpose of the Study
To evaluate the outcomes of distal radius fractures associated with or without an injury of the TFCC.Methods
Patients undergoing operative treatment for distal radial fracture were prospectively enrolled (n = 70). The TFCC was examined by wrist arthroscopy, and injuries were classified according to Palmer. Comparative analyses were performed on data from 45 patients with TFCC injury (the injured group) and 25 patients with an intact TFCC (the intact group). The outcome measures included The Patient-Rated Wrist Evaluation (PRWE) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires, 3 and 12 months after injury.Results
The TFCC was injured in 45 patients (64%). In patients with an intact TFCC, the mean total PRWE score was 27 (at 3 months) and 16 (at 12 months), whereas in patients with TFCC injury, it was 40 (at 3 months) and 24 (at 12 months). Mean DASH scores were 26 and 13 for the intact group and 39 and 27 for the injured group at 3 and 12 months, respectively. PRWE and DASH results showed significant difference at 3 and 12 months when compared using the Mann-Whitney test.Conclusions
Disability outcomes were worse in patients with distal radial fracture where TFCC was injured. TFCC injuries are an important cofactor affecting the outcome of distal radial fractures. 相似文献17.
Joshua J. Weis Deborah Farr Kareem R. Abdelfattah Deborah Hogg Daniel J. Scott 《American journal of surgery》2019,217(2):244-249
Background
Pre-internship boot camps have become popular platforms to rapidly teach skills to surgical interns. This study aimed to analyze psychomotor skill retention four months after completing a boot camp program.Methods
Surgical interns (n?=?20) took a baseline pre-test and then trained to proficiency (based on time and errors) for 5 knot tying, 4 simple suturing, and 2 running suturing tasks during a three-day boot camp. Three months later, all interns took a retention test.Results
Proficiency scores significantly improved on all task types from pre-test to post test and significantly regressed on all task types from post-test to retention test. Normalized scores decreased as the tasks became more complex (knot tying?=?93.5, simple suturing?=?89.1, running suturing?=?85.2, p?=?0.05).Conclusions
Boot camp style training can rapidly teach fundamental surgical skills to novices; however, skills regress significantly over time with a greater degree of regression seen on more complex skills. 相似文献18.
Michihiro Osumi Masahiko Sumitani Hiroaki Abe Yuko Otake Shin-ichiro Kumagaya Shu Morioka 《Journal of hand therapy》2019,32(1):41-47
Introduction
Chemotherapy-induced peripheral neuropathy (CIPN) usually affects both sensory and motor function of hands and feet, resulting in impaired skilled hand function (e.g., typing a keyboard). However, quantitative and objective evaluations for this condition have not been established.Purpose of the Study
We evaluated skilled hand function using a kinematic analysis and investigated relationships among hand kinematic function and the clinical sensory and motor features of CIPN.Study Designs
Clinical measurement.Methods
Twelve CIPN patients and 12 age-matched control participants were enrolled. We recorded their reach and grasp movements using a three-dimensional measurement system, and calculated the normalized jerk of these movements as quantitative indexes of skilled hand function. Additionally, we used the number of sequential hand grip–release cycles in 10 seconds as an evaluation of clinical motor function.Results
Our kinematic analyses revealed significant difference in normalized jerk of grasp movement (CIPN: 3.7 ± 0.2, control: 3.4 ± 0.1; P = .005), but this was not the case for reach movement (CIPN: 2.5 ± 0.1, control: 2.5 ± 0.2; P = .43), indicating that the distal part of the forearm is particularly affected in CIPN. Such disturbed grasp movement was directly correlated with poor scores on the hand grip–release test and the sensory tests.Discussion
We revealed deficit impaired hand function objectively and quantitatively in CIPN patients using a kinematic analysis. Further, the hand grip test could represent such kinematic abnormality and could be useful for evaluating skilled hand function of CIPN patients.Conclusions
Our kinematic and clinical measurements objectively and quantitatively evaluate skilled hand function in individuals with CIPN in clinical settings.Level of Evidence
Cross-sectional observational study. 相似文献19.
M. Arlaban P. Barreda M.A. Ballesteros E. Rodrigo B. Suberviola R. Valero E. Miñambres J.C. Ruiz-San Millán 《Transplantation proceedings》2019,51(2):311-313
Introduction
We aimed to evaluate if ex vivo machine perfusion could minimize the negative impact of cold ischemia on those renal grafts obtained from controlled donation after circulatory death (cDCD).Material and methods
Prospective observational paired study of kidney transplants from cDCD performed in our center. The kidney from each pair preserved on ice was transplanted first within the first few hours following procurement, while the contralateral kidney was machine-perfused with a LifePort device (Organ Recovery Systems, Brussels, Belgium) and transplanted the following day.Results
A total of 12 cDCDs were included. No differences were observed in delayed graft dysfunction or graft survival between the 2 groups.Conclusion
The use of ex vivo perfusion devices is simple and they do not require any large infrastructural or high economic investments, considering the fact that it allows a better selection of recipients and viable organs no longer need to be discarded because of prolonged warm ischemia times. 相似文献20.
Tarik Wasfie Avery Jackson Caramarie Brock Stefanija Galovska Jennifer R. McCullough Jacob A. Burgess 《American journal of surgery》2019,217(3):557-560