共查询到20条相似文献,搜索用时 15 毫秒
1.
Purpose
Patients with an upper brachial plexus lesion can suffer from dysfunction, joint deformities and instability of the shoulder. The goal of this study was to determine pain, shoulder function, patient satisfaction and muscle strength in shoulder arthrodesis in patients with an upper brachial plexus lesion more than 15 years after surgery.Methods
We retrospectively studied 12 patients with a brachial plexus lesion of mean age 46 years (27–61). At a mean of 19.8 years (15.4–30.3) after shoulder arthrodesis, patient-reported outcome measures (PROMs), range of motion (e.g., active and passive), patient satisfaction, strength of the affected and non-affected side (e.g., maximum isometric strength in Newton in forward and retroflexion, ab- and adduction, internal and external rotation) and position of fusion were obtained. PROMS consisted of the Visual Analogue Scale (VAS; 0–100, 0 being painless) for pain and the Disabilities of the Arm, Shoulder and Hand Score (DASH; 0–100, 0 being the best score) for function.Results
At latest follow-up, the median VAS pain score was 49 (0–96) and 0 for, respectively, the affected and unaffected side. The DASH was 15 (8–46), meaning a reasonable to good function of the upper extremity. Active and passive retroflexion was significantly different (p = 0.028). All subjects stated that in the same situation they would undergo a shoulder arthrodesis again. The unaffected side was significantly stronger in every direction. Arthrodesis showed position of fusion of 31° (12–70) abduction, 20° (10–50) forward flexion and 22° (? 14 to 58) internal rotation. The unaffected side was significantly (p ≤ 0.05) stronger in every movement direction.Conclusion
At a mean of 20 years after shoulder arthrodesis, patients with an upper brachial plexus lesion are still satisfied with a good to moderate functional improvement.Level of evidence III
A retrospective cohort study.2.
Kim Robin Spekreijse Guus Maarten Vermeulen Thybout M. Moojen Harm P. Slijper Steven E. R. Hovius Ruud W. Selles Reinier Feitz 《European journal of plastic surgery》2016,39(5):345-352
Background
Hypermobility of the first carpometacarpal joint is mostly surgically treated with a volar approached stabilization by Eaton, but recent studies indicate the importance of the dorsoradial and intermetacarpal ligaments (DRL and IML) for carpometacarpal joint stability. The aim of this study was to compare a dorsal and volar technique for primary carpometacarpal hypermobility regarding pain and functional outcome.Methods
Patients with non-degenerative, painful carpometacarpal hypermobility were included and were randomly assigned to either the volar technique using the FCR, or a dorsal technique using the ECRL. After premature termination of the trial, we followed all patients treated with the volar approach. Pain, strength, and ADL function using DASH and Michigan Hand Questionnaires (MHQ) were measured at baseline and 3 and 12 months after surgery.Results
After including 16 patients, the randomized trial comparing the volar and dorsal technique was terminated because of significant increased pain in the dorsal group. Although none of the other outcome measures were significant in the underpowered comparison, in line with the pain scores, all variables showed a trend towards a worse outcome in the dorsal group. Between 2009 and 2012, 57 thumbs were surgically stabilized. We found significant better pain and MHQ scores, and after 1 year improved grip and key pinch strength. Patients returned to work within 8 (±7) weeks, of which 85 % in their original job.Conclusions
Surgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength. We recommend a volar approach.Level of Evidence: Level I, therapeutic study3.
Background
It is unclear whether isolated gastroc/soleus tightness can increase the risk of lower extremity injury in an otherwise healthy child.Questions/Purposes
(1) Is there a difference in gastroc/soleus tightness, as represented by ankle dorsiflexion with the knee extended, in children presenting with upper versus lower extremity complaints? (2) Is there a difference in gastroc/soleus tightness in children presenting with atraumatic versus traumatic lower extremity complaints?Methods
We performed a cross-sectional study of 206 consecutive walking age children presenting to a county orthopedic clinic with new upper or lower extremity complaints. Passive ankle dorsiflexion was measured based on the lateral border of the foot versus the anterior lower leg with the knee fully extended and the foot in inversion.Results
Average age was 10.0?±?4.5 years. In the 117 patients presenting with upper extremity complaints, ankle dorsiflexion was 15.0°?±?11.6°. Of the lower extremity patients, 40 presented without trauma, with dorsiflexion of 11.8°?±?14.5°, while 49 presented with trauma, with dorsiflexion of 6.5°?±?12.0°. Multiple regression analysis found significantly decreased ankle dorsiflexion with increasing age and in the lower extremity trauma group. Twelve percent of upper extremity patients had 0° or less of dorsiflexion, as compared to 25% of lower extremity nontrauma patients and 41% of lower extremity trauma patients.Conclusions
Patients presenting with lower extremity trauma had significantly more gastroc/soleus tightness in their well leg than patients presenting with upper extremity complaints. Gastroc/soleus tightness may present a simple target for reducing lower extremity injury rates in children.4.
5.
Purpose
The aim of our study is to show the functional outcomes and complication rates of humeral complex fractures in adults, using osteosynthesis with two bridging orthogonal submuscular plates.Methods
The study consists of a prospective case series of 13 patients with isolated humeral complex fractures treated with two bridging orthogonal submuscular plates. Functional assessment was performed using disabilities of the arm, shoulder, and hand (DASH) score with 30 items. The age ranged from 22 to 68 years, with a mean age of 39 years. Functional assessment with DASH score was performed at the twelfth postoperative week.Results
All patients presented fracture healing in the fourth postoperative month. Of the 13 patients, five (38%) had a DASH score of zero (best function possible). One patient developed neuropraxis and presented with a score of 100 (worst possible). One case developed superficial infection, which was treated with oral antibiotics and local debridement.Conclusions
This study demonstrated satisfactory functional outcome in patients with distal-third diaphyseal humeral complex fractures treated with two locked submuscular plates. The authors consider it as a safe method and an efficient alternative, especially in younger patients who require early functional recovery.6.
Introduction
Surgical treatment is indicated for the management of Neer type IIB fractures of the distal third of the clavicle. The aim of this study was to assess the clinical and radiological outcomes, in cases of unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures.Methods
Nine patients with unstable distal third clavicle fractures (Neer type IIB) managed arthroscopically by means of a conoid ligament reconstruction and fracture cerclage with sutures, between 2008 and 2012, were included. The QoL was evaluated at the last follow-up visit, by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the constant score, and a Global Satisfaction scale (from 0 to 10). The mean time from fracture fixation until radiological union, the development of hardware loosening, nonunion, infections, and hardware skin discomfort were evaluated.Results
The mean age was 36 [21–48] years old. The mean [range] time from surgery until the last follow-up visit was 49 [46–52] months. Values of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (50.72 ± 6.88); (2) mental SF36 score (50.92 ± 11.65); (3) VAS for pain (1.86 ± 1.35); (4) DASH questionnaire (11.97 ± 7.03); (5) constant score (89.67 ± 8.55), and (6) Global Satisfaction (8.17 ± 0.98). The mean time elapsed from fracture fixation to radiological union was 8.41 ± 3.26 months. Hardware loosening was observed in none of the patients. Nonunion was observed in 11.11% (1/9) of the patients. Hardware skin discomfort was observed in 11.11% (1/9) of the patients.Conclusion
Patients with unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures may have good clinical and radiological outcomes, with no need for a second surgical procedure to remove any metal hardware.Level of evidence
Therapeutic; case series, Level IV.7.
8.
T. Pillukat R. Fuhrmann J. Windolf J. van Schoonhoven 《Operative Orthopadie und Traumatologie》2016,28(1):47-64
Objective
Bony healing of dislocated distal radius fractures after open reduction and internal stabilization by locking screws/pins using palmar approach.Indications
Extraarticular distal radius fractures type A2/A3, simple extra- and intraarticular fractures type C1 according to the AO classification, provided a palmar approach is possible.Contraindications
Forearm soft tissue lesions/infections. As a single procedure if a volar approach not possible.Surgical technique
Palmar approach to the distal radius and fracture. Open reduction. Palmar fixation of the plate to radial shaft with single screw. After fluoroscopy, distal fragments fixed using locking screws.Postoperative management
Below-the-elbow cast for 2 weeks. Early exercise of thumb and fingers, wrist mobilization after cast removal. Complete healing after 6–8 weeks.Results
Ten patients averaged 100?% range of motion of the unaffected side after 43±21 months. No complications observed. DASH score averaged 12±16 points; Krimmer wrist score was excellent in 7, good in 2, and fair in one.9.
Michael Hackl Kilian Wegmann Tim Leschinger Alexander Borda Lars Peter Müller 《Obere Extremit?t》2016,11(3):172-177
Background
Arthroscopic arthrolysis is a minimally invasive but technically demanding treatment option for elbow stiffness. Prospective clinical data are limited thus far.Objectives
The aim was to analyze the clinical short-term results of arthroscopic elbow arthrolysis and to evaluate factors predictive of the outcome.Materials and methods
28 patients (16 men, 12 women) following arthroscopic arthrolysis were enrolled in this study. The VAS (visual analogue scale) score, range of motion (ROM), and DASH score were obtained preoperatively as well as 6 weeks and 12 months after surgery. Posttraumatic elbow stiffness was present in 15 cases, elbow stiffness was due to primary osteoarthritis in 10 cases and due to other reasons in 3 cases. Osteoarthritis was absent in 1 case, grade 1 osteoarthritis was present in 7 cases, grade 2 in 9 cases and grade 3 in 11 cases according to the Broberg and Morrey classification.Results
The VAS score was 5.3 ± 2.4 points preoperatively and decreased to 2.8 ± 2.7 points after 6 weeks and 1.6 ± 1.8 points after 12 months (p ≤ 0.001). The ROM increased from 86± 30° to 106± 28° after 6 weeks and to 121± 18° 12 months postoperatively (p ≤ 0.01). The DASH score improved from 39.3 ± 17.8 points to 23.8 ± 15.7 points after 6 weeks and to 11.3 ± 8.7 points 12 months postoperatively (p ≤ 0.001). Sex, age, grade of osteoarthritis and cause of elbow stiffness were not predictive of the clinical outcome. Complications were seen in 2 patients (7?%).Conclusions
Arthroscopic arthrolysis represents an effective treatment method for elbow stiffness, which increases the range of motion, decreases pain levels and thus improves the functionality of the affected extremity regardless of sex, age, severity of osteoarthritis and etiology of elbow stiffness.10.
K.-H. Frosch R. Akoto T. Drenck M. Heitmann C. Pahl A. Preiss 《Operative Orthopadie und Traumatologie》2016,28(3):193-203
Objective
An arthroscopic technique for the reconstruction of the posterolateral corner combined with posterior cruciate ligament (PCL) reconstruction was developed.Indications
Posterolateral rotational instabilities of the knee. Combined lesions of the PCL, the popliteus complex (PLT) and the posterolateral corner. Isolated PLT lesions lacking static stabilizing function.Contraindications
Neuromuscular disorders; knee deformities or fractures; severe posterolateral soft tissue damage.Surgical technique
Six arthroscopic portals are necessary. Using the posteromedial portal, resect dorsal septum with a shaver. Visualize the PCL, the lateral femoral condyle and the posterolateral recessus with the PLT. Dissect the popliteomeniscal fibers; retract PLT until sulcus popliteus is visualized. Drill a 6-mm tunnel anteriorly into the distal third of the sulcus popliteus. Visualize femoral footprint of the PLT and place an anatomical drill tunnel. Pull the popliteus bypass graft into the knee and fix with bioscrews. Fix the reconstructed PCL. In cases of additional LCL injury, reconstruct LCL with autologous graft.Postoperative management
Partial weight-bearing for 6 weeks, range of motion exercises, quadriceps-strengthening exercises on postoperative day 1. Full extension allowed immediately with flexion limited to 20° for 2 weeks, to 45° for up to week 4, and to 60° up to week 6. Use a PCL brace for 3 months, running and squatting exercises allowed after 3 months.Results
In the 35 patients treated, no technique-related complications. After 1 year, 12 patients had a mean Lysholm Score of 88.6 (± 8.7) points and a side-to-side difference in the posterior drawer test of 2.9 (± 2.2) mm (preoperative 13.3 [± 1.9] mm).Conclusion
Low complication risk and good and excellent clinical results after arthroscopic posterolateral corner reconstruction.11.
A. K. Bhat A. M. Acharya J. K. Narayanakurup B. Kumar P. S. Nagpal A. Kamath 《Musculoskeletal surgery》2017,101(3):275-281
Purpose
To assess patient satisfaction, functional and cosmetic outcomes of single-digit ray amputation in hand and identify factors that might affect the outcome.Methods
Forty-five patients who underwent ray amputation were evaluated, 37 males and eight females whose mean age was 36.6 years ranging between 15 and 67 years. Twenty-eight patients had dominant hand involvement. Twenty-one patients underwent primary ray amputation, and 24 patients had secondary ray amputation. Eight out of the 23 patients with central digit injuries underwent transposition. Grip strength, pinch strength, tactile sensibility and functional evaluation using Result Assessment Scale (RAS) and DASH score were analysed. Cosmetic assessment was performed using visual analogue scale (VAS) for cosmesis.Results
Median time of assessment after surgery was 20 months. Average loss of grip strength and pinch strength was found to be 43.3 and 33.6%, respectively. Average RAS score was 3.75. Median DASH score was 23.4. Eighty-three percentage of patients had excellent or good cosmesis on the VAS. Transposition causes significant increase in DASH scores for central digit ray amputations but was cosmetically superior. Middle finger ray amputation had the maximum loss of grip strength, and index finger ray amputation had greater loss of pinch strength. Affection of neighbouring digits caused greater grip and pinch loss, and a higher DASH score. Primary ray resection decreased the total disability and eliminated the costs of a second procedure.Conclusion
Following ray amputation, one can predict an approximate 43.3% loss of grip strength and 33.6% loss of pinch strength. The patients can be counselled regarding the expected time off from work, amount of disability and complications after a single-digit ray amputation. Majority of the patients can return to the same occupation after a period of dedicated hand therapy.Level of Evidence
Therapeutic, Level III.12.
Background
The autogenous arteriovenous fistula (AVF) is the access of choice for hemodialysis therapy. Its timely and successful creation is particularly important to avoid hemodialysis catheters; however, according to the literature primary failure occurs in 20–50?% of newly created AVF.Objective
To identify factors influencing AVF maturation and thus identify predictors of successful fistula creation.Methods
We report on a prospective cohort study of 41 patients undergoing the first upper extremity AVF placement. Primary endpoint of the study was successful fistula maturation after 6 weeks and several constitutional, demographic, hemodynamic and technical factors were investigated.Results
The most significant predictive parameter for fistula maturation was flow volume measured in the access vein during surgery. The receiver operating characteristic (ROC) curve analysis showed a cut-off value of 170 ml/min for the blood flow volume with the best possible sensitivity (85?%) and maximum specificity (80?%) for prediction of fistula failure within 6 weeks.Conclusion
Intraoperative transit time flow measurement is easy to perform and can be used anytime to reliably predict successful AVF maturation.13.
Background
The treatment of patients with distal humeral fractures and reduced bone quality or complex fracture patterns is still complicated. Using angular stable implants should lead to better functional results.Objective
The clinical and functional results were analyzed as well as the complications after treatment of patients with distal humeral fractures using angular stable plate osteosynthesis.Material and methods
A questionnaire was sent to patients treated in our hospital for distal humeral fractures and they were invited for a follow-up examination. We investigated the DASH (Disability of the Arm, Shoulder and Head) score, Mayo Elbow Performance Score (MEPS) and EQ-5D-3?L for evaluation of functional results, as well as the VAS (“visuelle Analogskala”) score for evaluation of pain. Using radiographs the fracture patterns were classified and interpreted for complications.Results
A total of 28 patients returned the questionnaire after a minimum of 6 months following the operation and 10 attended a follow-up examination in our clinic. The DASH score was 38.40 and the MEPS 72.31. The results for 15 patients were good to excellent. The EQ-5D-3?L was 0.790 and the VAS 2.76. We found a significant correlation between the DASH score and patient age (p = 0.028), as well as an inverse correlation of the DASH score and the EQ-5D-3?L (p < 0.001). The complication rate was 53.6%. The three biggest groups of complications were neuronal complications, healing disorders and problems with the osteosynthesis material.Discussion
The treatment results showing that unsatisfactory results are possible even if angular stable plates are used. An inferior functional result as assessed by the DASH score reduces the quality of life measured by EQ-5D-3?L. A follow-up after 6 months appears to be sufficient to assess the outcome after complicated distal humeral fractures.14.
15.
Background
Pyrocarbon (PyC) interposition shoulder arthroplasty can be used to treat advanced collapse of the humeral head after avascular necrosis.Objectives
We examined outcomes for this bone-preserving implant which has a PyC coating and a novel biomechanical concept.Materials and methods
For a minimum of 2 years, we followed 10 patients (4 men, 6 women, 55.6 ± 12.9 years) treated with a free interposition PyC arthroplasty (“snookerball”) due to advanced humeral head collapse but with an intact glenoid and rotator cuff. Anteroposterior radiographs, the Constant score (CS), adjusted CS, DASH score, and the EuroQol 5D–5L score from the preoperative and the latest follow-up presentation were compared.Results
At a mean of 3.6 years (±15 months), the mean absolute CS was 70.6 (±13.6; adjusted CS 81.4 ± 16.4), the DASH score was 25.6 (±16.1), the mean EQ subjective VAS score was 72.6 (±15.9), and the EQ index score was 0.9 (±0.11). Scores improved: CS: +63.2 ± 12.9; adjusted CS: +72.9 ± 15.5; DASH: +47.2 ± 14.7; EQ VAS: +42.6 ± 16.8; EQ index score +0.52 ± 0.23. Mean glenoid erosion was 1.4?mm (±1.3?mm), thinning of the tuberosities was ?0.8?mm (±3.3?mm), and superior migration of the implant was 2.0?mm (±2.2). A thin radiolucent zone around the implant with bone densification on the metaphyseal side was observed in all cases (mean 1.8?±?0.6?mm).Conclusions
Excellent improvement of function and quality of life which are comparable to total shoulder arthroplasty data were observed. Significant bone remodeling occurs in the metaphysis around the implant. Further studies are needed to evaluate longevity and applicability of the implant. These results indicate that advanced collapse of the humeral head with an intact glenoid and rotator cuff are an optimal indication for this implant.16.
L. S. Khalil R. A. Keller N. Mehran N. E. Marshall K. Okoroha N. B. Frisch S. P. DeSilva 《Musculoskeletal surgery》2018,102(2):159-163
Purpose
The purpose of our study is to report the outcomes and complications in patients who underwent distal biceps tendon repair with the use of Botulinum toxin A (BoNT-A) as an adjunct to surgery.Methods
A retrospective review of 14 patients who underwent 15 distal biceps tendon repairs was performed. All repaired tendons had their correlating muscle bellies injected intraoperatively with a mixture of 100U of BoNT-A and 10 ml of normal saline. Each patient was evaluated for surgical and post-operative complications and followed with Disabilities of the Arm, Shoulder and Hand (DASH) Disability Scores.Results
The cohort was exclusively male, 14/14 (100%). The mean age at procedure was 52.1 years (range: 29–65 years). Types of injuries repaired included: 12 acute biceps tendon ruptures, one chronic partial (> 50% of tendon) biceps tear, and two chronic biceps ruptures. Average final follow-up was 32.9 months (SD: 19.6; range: 7.07–61.72). Average time to repair of chronic injury was 5.75 months (range: 2–12 months). There were no intraoperative complications, and all patients were discharged home on the day of surgery. Average DASH score at latest follow-up was 4.9 (range: 0.0–12.5). All patients had return of function of paralyzed muscle prior to final follow-up. One patient required an incision and drainage for a deep infection 1 week post-operatively, without any further complications. Another patient required operative removal of heterotopic ossification located around the tendon fixation site, which was the result of a superficial infection treated with antibiotics 2 weeks post-operatively. This patient later healed with improvement in supination/pronation range-of-motion and no further complications.Conclusions
Injection of BoNT-A is safe and effective to protect distal biceps tendon repair during the early phases of bone-tendon healing.Clinical relevance
BoNT-A may is safe and effective to protect distal biceps tendon repair. The utility of BoNT-A as an adjunct to surgical repair may be applicable to acute or chronic tears as well as repairs in the non-compliant patient without decreases in functional scores after return of function of the biceps muscle.Level of evidence
Level 4.17.
Objective
To clarify the contribution of the subcutaneous area during breast approach endoscopic thyroidectomy (BAET), with regard to invasiveness-related outcomes.Methods
Seventy-two patients were randomly assigned to two groups: standard dissection and limited dissection. Postoperative pain and inflammatory response were compared between groups.Results
The groups were well matched except for subcutaneous dissection area (137.11 ± 21.10 vs. 83.69 ± 12.10 cm2, p < 0.0001). No significant difference was found with regard to VAS score and postoperative inflammatory response.Conclusion
Our RCT indicated that the subcutaneous area plays a less important role with regard to BAET-related postoperative pain.18.
Introduction
The reconstruction of soft tissue defects with dead spaces in the heel and ankle is challenging. This article describes our experience in the reconstruction of such defects using the reverse sural flap with an adipofascial extension.Method
Reverse sural flaps with an adipofascial extension were used in 26 patients with soft tissue defects in the heel (n = 24) or ankle (n = 2). Extended adipofascial tissue was utilized to fill the dead space. The sizes of the adipofascial extensions varied from 2.0 to 5.0 cm in length and 4.0 to 12.5 cm in width.Result
Twenty-three flaps survived completely, and lateral marginal necrosis occurred in three flaps. All the recipient-site wounds healed without any signs of infection. The reconstruction outcomes were excellent in 20 patients and good in 6 patients according to the criteria of Boyden et al.Conclusion
The extended adipofascial tissue of the reverse sural flap improves closure of the dead spaces in soft tissue defects of the heel and ankle and thus provides beneficial conditions for the treatment of infection and reconstruction of both the function and contour of the soft tissue defects with dead spaces in the heel and ankle.19.
Background
The tasks involved in reconstructing the urethra after failed hypospadias repair range from correction of a trivial meatal stenosis to reconstruction of the entire anterior urethra.Objectives
To describe pathological findings in the urethra after failed hypospadias repair and the respective surgical methods used for their correction.Materials and methods
The various pathological findings after unsuccessful hypospadias surgery are classified according to their location and complexity.Results
The general rules of reconstruction that should be applied in each particular situation are described.Conclusions
Successful reconstruction of the urethra in patients with failed hypospadias surgery requires experience and good knowledge of the anatomy of the normal and hypospadic urethra and penis. Mastery of plastic surgical techniques and profound knowledge of the various surgical methods of hypospadias surgery are essential.20.
Shuhei?Ito Yuichiro?Kai Takaaki?Masuda Fumiaki?Tanaka Toshifumi?Matsumoto Yukio?Kamohara Hiroshi?Hayakawa Hiroaki?Ueo Hideki?Iwaguro Marc?H.?Hedrick Koshi?Mimori