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

Arthrosis of the thumb carpometacarpal joint is a very common, and often debilitating, affliction of postmenopausal women. Coexistent pathologic conditions are frequent. A thorough history and physical examination should lead the physician to an accurate diagnosis. Radiographs support the clinical suspicion and guide the treatment plan. Most patients, regardless of the severity of degeneration, will benefit from a conservative approach. However, when conservative management fails to relieve the patient’s symptoms adequately, surgical intervention is indicated. A plethora of surgical options are available, and controversy exists regarding the most effective surgical approach. Regardless of the technique used, one can usually expect pain relief, improved strength, and an overall increase in function. Therefore, satisfaction rates are high when surgery is performed on properly selected patients and associated conditions are addressed.

Preiser’s disease is a rare condition involving avascular necrosis of the scaphoid, in part or in whole. Diagnosis currently is made most frequently by standard radiographs and magnetic resonance imaging (MRI). Treatment options are varied because no large series of comprehensive results has been reported. Vascularized or conventional bone grafting, proximal row carpectomy, and scaphoid excision/4 bone fusion are performed most commonly. If possible, every attempt to save the scaphoid should be made.

Primary malignant bone and soft-tissue tumors of the hand are rare. Optimal treatment requires appropriate staging, biopsy examination, and definitive surgical treatment. Early referral to a cancer center is indicated particularly in those patients requiring multidisciplinary or systemic treatment.

A review of unusual forms of avascular necrosis in the hand and wrist, excluding that seen in the scaphoid and lunate, is presented. A summary of the literature findings and treatment options is reviewed although, in nearly all types, limited data are available.

Tumors of the brachial plexus frequently are not readily apparent and may masquerade as proximal or distal neurologic lesions. Potential pitfalls in diagnosing occult plexal lesions are numerous. Findings of severe pain, proximal and multiple peripheral nerve abnormalities, masses, or an atypical response to management should lead to imaging and electrodiagnostic evaluation of the brachial plexus.

Individuals who are immunocompromised, such as those with a diagnosis of diabetes or acquired immunodeficiency syndrome (AIDS), as well as patients immunosuppressed after transplantation or chemotherapy for oncologic reasons, are more prone to the development of infections in general, and, more specifically, infections of the hand. Most commonly, these hand infections are caused by organisms that are common to the skin but may show an unusual aggressive or atypical course. A small percentage of these patients are infected by atypical organisms that rarely cause infections in an immunocompetent individual. The surgeon who treats hand infections also must be aware of systemic conditions that can negatively impact the treatment of hand infections.

Fractures of the olecranon process are common in adults and reflect a spectrum of injuries to the elbow. This article provides an overview of the management for olecranon fractures, including a historic perspective, relevant anatomy, mechanism of injury, classification, evaluation, treatment, and reported outcome.