Journal of the American Society for Surgery of the Hand最新文献

Heterotopic ossification (HO) resulting in radioulnar cross-union occurs in approximately 2% of all forearm injuries and causes significant functional impairment. Risk factors for cross-union are incompletely understood, however, injuries to the proximal forearm account for the majority of cases. Concomitant central nervous system injury greatly increases the risk for HO after forearm fracture. Although surgical excision of forearm cross-union has produced mixed results in the past, and recurrence of synostosis has been common, more recent treatment attempts have resulted in nearly full recovery of forearm rotation. Questions remain regarding the appropriate timing for excision and the advisability of adjuvant low-dose radiotherapy to prevent recurrence. It would seem that HO resulting from local trauma in the absence of other risk factors can be safely excised 6 to 12 months after injury. Adjuvant radiotherapy may be warranted in more aggressive cases of HO with a greater risk for recurrence, such as those cases involving the proximal forearm or associated with closed head injury.

Although fungal infections of the hand and upper extremity are relatively uncommon, they are now being reported with increasing frequency. Immunocompromised patients are at especially high risk for these infections and hand surgeons should have a high index of suspicion for fungal infections in susceptible immunocompromised and diabetic patients and patients with hematologic malignancies and on chronic steroid medications. Because fungal infections often present with an indolent onset, diagnosis and treatment often are delayed. Definitive diagnosis only can be made with a surgical biopsy examination and special fungal stains and cultures. Early aggressive surgical treatment includes debridement of all involved soft tissues and bone, followed by adjuvant antifungal therapy.

Fractures of the distal radius are among the most common fractures treated by orthopedic surgeons. In the healed distal radius fracture, the discrepancy from actual alignment to anatomic alignment is malunion. Minimal malunion of the distal radius may be asymptomatic or cause mild to moderate clinical problems. With the increasing magnitude of distal radius malunion weakness, carpal instability, posttraumatic arthritis, ulnar carpal abutment, and other problems can occur, resulting in significant disability. Malunion of the distal radius should be scrutinized and treated with corrective osteotomy when clinically indicated.

Gout, a disorder in purine metabolism, has been written about since the time of Hippocrates. Manifestations of gout in the hand and wrist are well documented in terms of subcutaneous nodules and synovial involvement of joints and tendons. However, there is much less written about bone and ligament lesions of the wrist in association with gout. Three cases of bone lesions and 2 cases of ligament lesions of the wrist are documented. The presentations were varied. Treatment recommendations included medical management in most cases, with surgical intervention in selected cases.

Fractures and nonunions of the scaphoid are common and can present specific challenges for both diagnosis and treatment. We review the anatomy, cause, presentation, and various treatment options that may be considered by the surgeon, with a concentration on newer techniques.