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Indian Journal of Orthopaedics Apr 2024Tuberculous dactylitis is infrequently seen after the age of 6 years. The index and middle fingers are the most common sites. Early diagnosis is essential to eradicate...
Tuberculous dactylitis is infrequently seen after the age of 6 years. The index and middle fingers are the most common sites. Early diagnosis is essential to eradicate the infection. Delay in diagnosis and management leads to extensive involvement which may require surgical intervention. The current literature reveals conservative management gives satisfactory results in early stages. Though surgical intervention in Tuberculous dactylitis is seldom required, delay in diagnosis and management leads to extensive involvement of the bone and sequestration which does not respond to Anti Tubercular Therapy and needs staged surgical interventions. We report a case of an 11-year-old girl who presented to us after extensive involvement of 2nd and 3rd metacarpals and failed to respond to ATT even after 1.5 years of medication. She required staged surgeries to eradicate the infection which led to loss of 2nd and 3rd metacarpals. Complex reconstructive procedures of hand were required in stages and the bone loss was managed with non-vascularized Fibular strut graft. At 2 years of follow up, there is complete incorporation of the graft, and the patient has satisfactory functions of the hand and can carry out activities of daily living with ease.
PubMed: 38544544
DOI: 10.1007/s43465-024-01102-w -
[A multicenter clinical study on the treatment of lateral epicondylitis of humerus by manipulation].Zhongguo Gu Shang = China Journal of... Mar 2024To investigate clinical effect of tendons pulling,poking and kneading for the treatment of external humeral epicondylitis. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To investigate clinical effect of tendons pulling,poking and kneading for the treatment of external humeral epicondylitis.
METHODS
From January 2018 to December 2021,a multicenter randomized controlled study was performed to collect 192 patients with external humeral epicondylitis in Wangjing Hospital,Beijing Dianli Hospital,and Beijing Fengsheng Osteotraumatology Hospital,respectively,and they were divided into treatment group and control group by random number table method. There were 96 patients in treatment group,including 36 males and 60 females,aged from 28 to 60 years old with an average of (41.20±5.50) years old;the course of disease ranged from 1 to 14 days with an average of (5.24±1.35) days;they were treated once every other day for 2 weeks. There were 96 patients in control group ,including 33 males and 63 females,aged from 26 to 60 years old with an average of (43.35±7.75) years old;the course of disease ranged from 1 to 14 days with an average of (5.86±1.48) days;they were treated with topical voltaalin combined with elbow joint fixation for 2 weeks. Visual analogue scale (VAS) and Hospital for Surgery Scoring System (HSS) elbow pronation and supination angles,wrist metacarpal flexion and dorsal extension angles,elbow tenderness between two groups were compared before treatment and at 1,3,5,7,11 and 13 days after treatment;Hospital for Surgery Scoring System 2 (HSS2) was compared before treatment and the final treatment.
RESULTS
All patients were followed up for 10 to 14 days with an average of (12±1.6) days. VAS between treatment group and control group before treatment were 6.83±1.36 and 6.79±1.58,respectively,and decreased to 1.49±1.09 and 2.11±1.81 after the final treatment. VAS of treatment group were significantly lower than those of control group at 1,3,5,7,9,11 and 13 days after treatment (<0.05). HSS between two groups were 61.73±11.00 and 36.47±12.45 before treatment,respectively,and increased to 94.42±5.9 and 91.44±9.11 at the final treatment. HSS of treatment group were significantly higher than those of control group at 1,3,5,7,9,11 and 13 days after treatment (<0.05). On the 5th day after treatment,the external and internal rotation angles of elbow in treatment group were (66.41±12.69) ° and (66.35±13.54) °,while those in control group were (62.08±16.03) ° and (61.77±16.35) °. On the 7th day after treatment,the external and internal rotation angles of elbow were (69.79±12.64) ° and (70.02±13.55) ° in treatment group,and (65.28±15.86) ° and (65.09±16.67) ° in control group. Elbow joint motion in treatment group was higher than that in control group (<0.05). On the 5th day after treatment,angles of wrist dorsiflexion and palm flexion were (39.43±15.94) ° and (46.68±11.10) ° in treatment group,and (38.51±18.49) ° and (44.27±13.58) ° in control group. On the 7th day after treatment,angles of wrist dorsiflexion and palm flexion were (42.52±16.50) ° and (49.23±10.96) ° in treatment group,and (41.18±20.09) ° and (46.64±14.63) ° in control group. The motion of wrist joint in treatment group was higher than that in control group (<0.05). On the 13th day after treatment,HSS2 in treatment group 93.61±6.32 were higher than those in control group 92.06±7.94(<0.05). There was no significant difference in elbow tenderness between two groups at each time point (>0.05).
CONCLUSION
Voltaren external treatment combined with elbow fixation and tendons pulling,poking and kneading could effectively improve symptoms of external humeral epicondylitis. Compared with voltaren external treatment,tendons pulling,poking and kneading has advantages of longer analgesic time and better elbow function recovery.
Topics: Male; Female; Humans; Adult; Middle Aged; Tennis Elbow; Diclofenac; Treatment Outcome; Humerus; Elbow; Elbow Joint; Range of Motion, Articular; Retrospective Studies
PubMed: 38515411
DOI: 10.12200/j.issn.1003-0034.20230252 -
Journal of Nephrology Mar 2024Hyponatremia is implicated in pathological bone resorption and has been identified as a risk factor for bone fracture in the general population. However, there are...
BACKGROUND
Hyponatremia is implicated in pathological bone resorption and has been identified as a risk factor for bone fracture in the general population. However, there are limited data on the association between serum sodium levels and fracture risk in patients undergoing hemodialysis (HD).
METHODS
We analyzed a historical cohort of 2220 maintenance HD patients to examine the association between serum sodium levels and the risk of fracture and mortality. We also examined the association between serum sodium levels and osteoporosis, based on metacarpal bone mineral density, in a subcohort of 455 patients with available data. In addition, we examined the association between serum sodium levels and bone turnover markers in a separate cross-sectional cohort of 654 maintenance HD patients.
RESULTS
During a median follow-up of 5.4 years, 712 patients died, 113 experienced clinical fractures, and 64 experienced asymptomatic vertebral fractures. Lower serum sodium levels were associated with an increased risk of mortality (HR 1.06 per 1 mEq/L decrease; 95% CI 1.03-1.09) but not with the risk of clinical fracture (HR 1.04 per 1 mEq/L decrease; 95% CI 0.97-1.11). A similar lack of association was observed for asymptomatic vertebral fracture and any fracture. Serum sodium levels were also not associated with osteoporosis in a subcohort with available data (n = 455) or with bone alkaline phosphatase or tartrate-resistant acid phosphatase-5b in a separate cross-sectional cohort.
CONCLUSION
Serum sodium levels were associated with mortality but not with fracture risk, osteoporosis, or bone turnover markers in maintenance HD patients.
PubMed: 38512372
DOI: 10.1007/s40620-024-01904-z -
Ochsner Journal 2024Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and...
Repetitive microtrauma can lead to trapezoid and second metacarpal stress fractures in racket sport players. Nontraumatic trapezoid stress fractures are rare and difficult to diagnose. To our knowledge, only 3 cases had been reported as of May 2023. We report the fourth case of a nontraumatic sports-related trapezoid stress fracture and only the second case in a tennis player. A 29-year-old professional and right hand-dominant male tennis player presented with right hand and wrist pain for 3 weeks. He complained of dorsal wrist tenderness proximal to the base of the second metacarpal that was exacerbated by extension of the index finger. Initial radiographs were normal, but magnetic resonance imaging of the wrist showed a stress fracture of the trapezoid bone and base of the second metacarpal. The patient was treated conservatively with a wrist brace, cessation of sports activities, and modification of his training routine. The patient was asymptomatic at 1-year follow-up. This case highlights the relationship between trapezoid and second metacarpal stress fractures in athletes. A high index of suspicion for trapezoid stress fractures should be maintained and included in every differential diagnosis for athletes, especially racket sport players presenting with wrist pain. To avoid future injuries, clinicians should not only treat the fracture but also address the risk factors predisposing to this injury.
PubMed: 38510218
DOI: 10.31486/toj.23.0067 -
Hand (New York, N.Y.) Mar 2024Scaphoid fractures are less commonly reported in adults older than 50 years. The association between bone density and outcomes following scaphoid fractures has not been...
BACKGROUND
Scaphoid fractures are less commonly reported in adults older than 50 years. The association between bone density and outcomes following scaphoid fractures has not been explored in this patient population. The second metacarpal cortical percentage (2MCP) has been shown to predict low bone density. The purpose of this study is to describe the epidemiology and radiographic characteristics associated with scaphoid fractures in adults older than 50 years, determine the prevalence of osteopenia defined by 2MCP, and evaluate the characteristics associated with scaphoid nonunion in this population. We hypothesized that osteopenia defined by 2MCP would be common in this patient population and associated with scaphoid nonunion.
METHODS
Patients older than 50 years with an acute, closed scaphoid fracture were identified. Demographic data, radiographic characteristics, and outcome data were collected. The 2MCP was measured using standard hand radiographs.
RESULTS
A total of 111 patients were identified. Most fractures were nondisplaced and occurred in women via low-energy mechanism. Fifty-six patients (50.5%) had osteopenia defined by a 2MCP less than 60%. Nondisplaced fractures achieved union faster than displaced fractures ( < .05). Displaced, unstable fractures were statistically associated with nonunion ( < .001). 2MCP did not correlate with nonunion.
CONCLUSIONS
In adults older than 50 years, scaphoid fractures may represent a fragility fracture cohort given they occur more frequently in female patients via low-energy mechanisms and over half of the cohort had osteopenia defined by a 2MCP less than 60%. Displaced and unstable fractures were statistically more likely to go on to nonunion. Nonunion was not found to be associated with osteopenia.
PubMed: 38506444
DOI: 10.1177/15589447241235342 -
Journal of Medical Case Reports Mar 2024Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and...
BACKGROUND
Synovial sarcoma is a rare soft tissue sarcoma, with incidences of 0.81/1,000,000 in children and 1.42/1,000,000 in adults. It is most commonly found in soft tissue and rarely in bone. It often has a slow growth pattern and a benign radiologic appearance.
CASE PRESENTATION
This study reports a case of metacarpal synovial sarcoma occurring in the hand-wrist of a 32-year-old Iranian man presented with the chief complaint of a lump on the dorsal ulnar side of his left hand and wrist. Initially, the first physician suspected the case to be a ganglion cyst. After two months of conservative treatment, the size of the lesion gradually increased. Magnetic resonance imaging (MRI) was performed and after an excisional biopsy and a postoperative histological analysis, the tumor was identified as a synovial sarcoma. The patient underwent a scheduled surgical procedure. Unfortunately, he had poor follow-ups and brought the pathologic results two months later when, the tumor had incredible growth, which makes this presentation rare.
CONCLUSIONS
Since early diagnosis can lead to higher survival rates, this report increases doctors' awareness of this extremely malignant tumor that is rarely seen.
Topics: Adult; Humans; Male; Hand; Iran; Sarcoma; Sarcoma, Synovial; Ulna
PubMed: 38486309
DOI: 10.1186/s13256-024-04469-4 -
JBJS Case Connector Jan 2024A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large...
CASE
A 23-year-old right-hand dominant man presented with a high-velocity gunshot wound injury to the right thumb with severe soft-tissue damage, vascular injury, and large osseous defect of the right thumb metacarpal. The patient was successfully treated with metacarpophalangeal joint arthrodesis and metacarpal reconstruction using definitive external fixation, an intramedullary Kirschner wire, and use of the Masquelet bone grafting technique.
CONCLUSION
The authors' treatment approach for a mangled thumb injury with definitive external fixation and utilization of the Masquelet technique resulted in restoration of a large osseous defect, avoidance of infection, and limited loss of mobility.
Topics: Humans; Male; Young Adult; External Fixators; Fracture Fixation; Hand Injuries; Plastic Surgery Procedures; Thumb; Wounds, Gunshot
PubMed: 38484095
DOI: 10.2106/JBJS.CC.23.00390 -
Animals : An Open Access Journal From... Mar 2024Metacarpophalangeal joint region pain is a common cause of lameness in racehorses. Radiological abnormalities in the sagittal ridge (SR) of the third metacarpal bone...
Metacarpophalangeal joint region pain is a common cause of lameness in racehorses. Radiological abnormalities in the sagittal ridge (SR) of the third metacarpal bone have been associated with joint effusion, lameness and reduced sales prices. The aims were to describe computed tomographic (CT) appearance of the SR in racehorses, and to document the progression of these findings over three assessments. Forty yearlings were enrolled at the first examination (time 0). Re-examinations were performed twice, approximately six months apart on 31 (time 1) and 23 (time 2) horses, respectively. Computed tomographic examinations of both metacarpophalangeal regions were performed with the horses in a standing position. Computed tomographic reconstructions were analysed subjectively and objectively. The mean Hounsfield Unit values (Hus) of eight radial segments and location, size and shape of hypoattenuating lesions were recorded. Mean Hus at time 1 were higher than at time 0. There was no difference between mean HU at times 1 and 2. The mean HU values of the dorsal half were higher in the right forelimbs and in fillies. Hypoattenuation was identified in 33/80 (41.3%) limbs at time 0, in 22/62 (35.5%) limbs at time 1 and in 14/46 (30.4%) limbs at time 2. All hypoattenuations were located in the dorsodistal aspect of the SR. The most common shapes were hypoattenuating lesions elongated proximodistally and those extending towards trabecular bone. An increase in attenuation of the SR occurred in the first six months of training. Hypoattenuating lesions could decrease in size and could resolve during early training. In this population, these lesions were not associated with lameness.
PubMed: 38473196
DOI: 10.3390/ani14050812 -
Zhonghua Shao Shang Yu Chuang Mian Xiu... Feb 2024To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. The study was... (Observational Study)
Observational Study
To explore the effect of accurately localized mini anterolateral thigh perforator flap in repairing medium-sized skin and soft tissue defects in fingers. The study was a retrospective observational study. From December 2019 to September 2022, 15 patients with medium-sized skin and soft tissue defects who met the inclusion criteria in fingers were admitted to the Second Affiliated Hospital of Wenzhou Medical University, including 12 males and 3 females, aged 23 to 62 years. After debridement, the wounds were all accompanied by exposed tendons, bones, vessels and nerves, with an area from 4.0 cm×3.0 cm to 8.0 cm×3.5 cm. Computed tomography angiography and color Doppler ultrasonography examinations were performed on both lower limbs of the patient before surgery to accurately locate the anterolateral thigh perforators. When the flap with area from 6.0 cm×3.0 cm to 11.0 cm×4.0 cm was harvested, the flap was thinned. The artery and vein perforators of the flap were anastomosed respectively with the digital artery and dorsal metacarpal vein. If there was avulsion injury, infection, or burn in the recipient area, the main arterial and veinous vessels carried by the skin flap was anastomosed with the radial artery and accompanying vein. The lateral thigh cutaneous nerve carried by the flap was anastomosed with the stump of the digital nerve. The types of perforators of the lateral thigh artery were observed during operation and compared with the location of the vessels before operation. After operation, the survival and adverse complication of the flap were closely observed. During follow-up, the skin flap color, texture, and shape were observed; the wound healing in donor area was observed. At the last follow-up, the two-point discriminative distance of the affected finger pulp was measured, and the function of the affected finger was evaluated using the trial standard for the evaluation of functions of upper limbs of Hand Surgery Society of Chinese Medical Association, and the interphalangeal joint movement of the affected finger was observed; the patients' complaints about the adverse effects of flap resection on lower limbs were recorded. During the operation, it was observed that the perforators of the flaps in 11 patients were the descending branch of the lateral circumflex thigh artery, in two patients, the perforators of skin flaps were the oblique branch of the lateral thigh artery, and the perforators in another two patients were the transverse branch of the lateral circumflex thigh artery, which were consistent with the preoperative vascular localization. After operation, all flaps survived without vascular crisis and infection. The patients were followed up for 6-12 months, the flaps had excellent color, texture, and appearance; only linear scars remained on the donor wound. At the last follow-up, the two-point discrimination distance in the finger pulp was 7-11 mm; the affected finger function was rated as excellent in 6 cases, good in 6 cases, and fair in 3 cases; the flexion and extension function of the finger was not affected; two patients complained of numbness in the lateral thigh after excision of the skin flap, and the other 13 patients had no complain of adverse complaints. The perforating branch in lateral thigh region can be accurately located by computed tomography angiography and color Doppler ultrasonography, accurate positioning of perforators before operation can reduce the damage to the donor area during the incision of the flap, the appearance and function of the affected finger can be restored to the maximum extent by thinning the transplanted flap and rebuilding the finger sensation. Therefore, it is an effective and reliable way to repair the medium-sized skin and soft tissue defects of fingers with the mini thigh anterolateral perforator flap.
Topics: Male; Female; Humans; Thigh; Perforator Flap; Plastic Surgery Procedures; Soft Tissue Injuries; Lower Extremity
PubMed: 38418178
DOI: 10.3760/cma.j.cn501225-20231030-00150 -
International Emergency Nursing Mar 2024Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED)...
'I just need to find out if I had broken something or not.' A qualitative descriptive study into patient decisions to present to an Emergency Department with a simple fracture.
Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments.
Topics: Adult; Humans; Health Services Accessibility; Australia; Emergency Service, Hospital; Fractures, Bone; Qualitative Research
PubMed: 38408404
DOI: 10.1016/j.ienj.2024.101420