微型骨锚联合掌长肌腱腱片移植治疗陈旧性锤状指畸形

目的探讨微型骨锚联合掌长肌腱腱片移植治疗陈旧性锤状指畸形的疗效。方法本组共16例陈旧性锤状指畸形患者,均采用微型锚钉联合掌长肌腱腱片重建伸肌腱止点的方法进行治疗,术后6周开始功能锻炼。定期随访,并进行功能评定。结果随访时间为4～10个月。本组患者术后未出现伤口感染或骨锚植入后异物反应,X线检查未见骨锚松动及脱落。术后远侧指间关节稳定性良好。按Dargan方法评定主动活动范围,优12例,良2例,可l例,差l例。结论微型骨锚联合掌长肌腱腱片移植治疗陈旧性锤状指畸形,手术简便,可明显纠正畸形,效果肯定,值得推广应用。     

Current concepts: mallet finger

Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.     

Causes of Procedural Failures of Closed Reductions using an Extension-Block Pin for Bony Mallet Finger

This retrospective study evaluated procedural failures of closed reductions using an extension-block Kirschner wire (K-wire) for bony mallet finger. A total of 132 patients who underwent a closed reduction for bony mallet finger in a procedure using an extension-block K-wire were radiographically assessed. Radiographs were used to evaluate (1) postoperative displacement of the reduction before or after K-wire removal and (2) inaccurate reduction of the fragment immediately after surgery. The causes of procedural failure and bone union were evaluated using radiographs and medical records of the intraoperative findings. Out of 132 patients, 17 with procedural failure were enrolled. Displacement of the reduction before and after K-wire removal occurred in seven and six cases, respectively. Inaccurate reduction immediately after surgery occurred in four cases. The most common cause of procedural failure was inaccurate insertion of the K-wire to fix the distal interphalangeal joint (eight cases) followed by inaccurate insertion of the extension-block pin (five cases). All patients had bone union regardless of the displacement of the reduction or inaccurate reduction of the fragment. Caution should be exercised during the reduction and fixation when an extension-block K-wire is used in a closed reduction procedure.     

Duodenal Injuries: A Review

Abstract Duodenal injuries are uncommon injuries but are associated with significant morbidity and mortality from a delayed diagnosis in the case of blunt trauma and associated major vascular injuries in penetrating trauma. A simplistic approach with primary repair or resection and anastomosis is ideal for the vast majority. Complex procedures such as pyloric exclusion with or without gastrojejunostomy may be indicated for delayed treatment or severe, high-grade combined pancreato-duodenal injuries. A high index of suspicion and a judicious treatment plan based on a careful consideration of all the available options are crucial for optimal outcome.     

睾丸损伤31例报告

目的:报告我院收治的31例32个睾丸损伤,总结诊治经验。方法:在31例睾丸损伤中,闭合性损伤26例,开放性损伤5例。保守治疗9例(其中2例改为手术治疗),直接手术治疗22例。结果:随访25例(26个睾丸),其中保守治疗9例,手术治疗16例。随访时间7个月~9年。保守治疗组和手术组各有2例睾丸萎缩;无1例睾丸硬化和慢性疼痛。结论:对任何阴囊、会阴外伤均应考虑睾丸损伤的可能,常规首选B超检查;在B超的密切监护下实施保守治疗;对手术探查应持积极的态度。     

Burns and socioeconomic deprivation: the experience of an adult burns centre

IntroductionBurns incidence, mortality and complication rates have been shown to be directly correlated by race, gender and socioeconomic status. As such, socioeconomic status (SES) has been previously highlighted as a target for burn prevention in the UK and abroad.The Queen Elizabeth Hospital, Birmingham (QEHB) is the regional Burns Centre for the Midlands Burn Network, supporting a population of 13.7 millionMethods16-year retrospective review was performed of all acute adult burns assessed by the Burns and Plastics Department, QEHB. The data included patient demographics (age, gender, ethnic origin and postcode), mechanism of injury, total body surface area (TBSA) affected and whether first aid was given. IMD Rank, IMD Scores were obtained from individual postcodes, as well as incidence data per electoral ward.ResultsIn our analyses there were 3369 total acute admissions and acute assessments. 812 patients (24.1%) were in the most deprived decile. 1715 patients (50.9%) live within the 3 most deprived deciles. The deciles with the lowest completion of first aid were the first (524, 70.72%), third (257, 72.39%) and second (351, 72.82%).ConclusionsThis study shows patients from the most deprived areas are over-represented in burns incidence and are less likely to perform first aid. We feel this should be highlighted in burns prevention and education strategies.     

Craniocerebral War Missile Injuries: Clinical and Radiological Study

In this study we reviewed the initial clinical and radiological management and early outcomes of 176 consecutive patients from the war in Croatia.