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Intra-Articular Antegrade Intramedullary Screw Fixation for Proximal Phalanx Fractures: Impact of Articular Surface Defects on Joint Contact Pressures. 近端指骨骨折的关节内前向髓内螺钉固定术:关节面缺陷对关节接触压力的影响。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-26 DOI: 10.1177/15589447231174045
Chelsea C Boe, Scott Telfer, Stephen Kennedy

Background: Intramedullary headless screw fixation is increasingly used for fixation of proximal phalanx fractures. However, the impact of screw entry defects on joint contact pressures is not well defined and may have implications for arthrosis. The objective of this cadaveric biomechanical study was to assess joint contact pressures at the metacarpophalangeal (MCP) joint before and after passage of 2 sizes of antegrade intramedullary fixation.

Methods: Seven fresh frozen cadaver specimens without arthritis or deformity were included in this study. Antegrade intramedullary screw fixation of proximal phalanx fracture was simulated using an intra-articular technique. Flexible pressure sensors were inserted into the MCP joints and cyclic loading was performed. Peak contact pressures were determined and averaged across loading cycles for each finger in the native state, with 2.4- and 3.5-mm drill defects in line with the medullary canal.

Results: Peak pressure increased with the size of the drill hole defect. Contact pressure increases were greater in extension, with peak contact pressures increased by 24% for the 2.4-mm defect and 52% for the 3.5-mm defect. Increase in peak contact pressure was statistically significant with a 3.5-mm articular defect. Contact pressures were not consistently increased for the 2.4-mm defect. Testing in flexion of 45° resulted in reduced contact pressure for these defects.

Conclusions: Our study demonstrates that antegrade intramedullary fixation of proximal phalanx fractures can increase MCP joint peak contact pressures, particularly in an extended joint position. Effect increases with defect size. This has implications for the management of proximal phalanx fractures using this technique.

背景:髓内无头螺钉固定越来越多地用于近节指骨骨折的固定。然而,螺钉入口缺陷对关节接触压力的影响尚未得到很好的界定,而且可能会对关节炎产生影响。这项尸体生物力学研究的目的是评估掌指关节(MCP)在通过两种规格的前向髓内固定前后的关节接触压力:方法:本研究包括七具无关节炎或畸形的新鲜冷冻尸体标本。采用关节内技术模拟近节指骨骨折的胫骨内固定。将柔性压力传感器插入 MCP 关节并进行循环加载。在原始状态下,每根手指的接触压力峰值被测定,并在加载周期中取平均值,钻孔缺损为 2.4 毫米和 3.5 毫米,与髓质管一致:峰值压力随钻孔缺损的大小而增加。伸展时接触压力增加更大,2.4 毫米缺损的峰值接触压力增加了 24%,3.5 毫米缺损的峰值接触压力增加了 52%。3.5 毫米关节缺损的峰值接触压力增加具有统计学意义。2.4 毫米缺损的接触压力没有持续增加。在屈曲 45° 的情况下进行测试可降低这些缺损的接触压力:我们的研究表明,近节指骨骨折的前向髓内固定可增加 MCP 关节峰值接触压力,尤其是在关节伸展位置。这种影响随缺损大小而增加。这对使用该技术治疗近端指骨骨折具有重要意义。
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引用次数: 0
Canal Fill of the Forearm Bones When Placing Intramedullary Nails in the Pediatric and Adolescent Populations. 在儿童和青少年群体中植入髓内钉时前臂骨的髓腔填充。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-06-11 DOI: 10.1177/15589447231175514
Max Hamaker, Casey M Codd, Catherine C May, Nathan N O'Hara, Joshua M Abzug

Background: In the lower extremity, studies have suggested an optimal nail diameter to medullary canal diameter (ND/MCD) ratio to minimize postoperative complications. The goal of this study was to determine whether a correlation exists between the occurrence of complications, angulation, and range of motion and the ratio of the ND/MCD in the upper extremity.

Methods: A total of 85 radius and ulna fractures treated with flexible intramedullary nails had ND/MCD ratios measured. Random-effects models were developed to determine the association between complications and ND/MCD ratio, angulation and ND/MCD ratio, and range of motion and ND/MCD ratio. The results were reported for unadjusted models and adjusted models.

Results: Of the 85 forearm fractures treated with intramedullary nailing, there were 3 complications. The average follow-up was 6 months. The ND/MCD ratios were categorized as <0.50, 0.50 to 0.59, and ≥0.60. There was not a significant association between the different ratios and angulation, or risk of complication. There was an association between the ND/MCD ratio ≥0.60 and decreased pronation of -1.58° (-2.77° to -0.38°) and supination of -2.68° (-4.91° to -0.46°) (P < .05).

Conclusion: This study found that there was not an association between the nail to canal diameter ratio and postoperative angulation in forearm fractures treated with flexible intramedullary nails. When choosing a flexible nail for forearm fractures, there does not appear to be an optimal ratio; it is therefore reasonable to use the ND that passes more easily.

背景:研究表明,在下肢,最佳的钉子直径与髓管直径(ND/MCD)比率可最大限度地减少术后并发症。本研究旨在确定上肢并发症的发生、成角和活动范围与 ND/MCD 的比率之间是否存在相关性:方法:共对 85 例使用柔性髓内钉治疗的桡骨和尺骨骨折进行了 ND/MCD 比值测量。建立随机效应模型以确定并发症与 ND/MCD 比值、成角与 ND/MCD 比值、活动范围与 ND/MCD 比值之间的关系。报告了未调整模型和调整模型的结果:结果:在使用髓内钉治疗的 85 例前臂骨折中,有 3 例并发症。平均随访时间为 6 个月。ND/MCD比率分为P<.05):本研究发现,在使用柔性髓内钉治疗前臂骨折时,钉与髓管直径比与术后成角之间并无关联。在选择治疗前臂骨折的柔性髓内钉时,似乎没有一个最佳比例;因此,使用更容易通过的髓内钉是合理的。
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引用次数: 0
Interposition Arthroplasty versus Dual Cup Mobility Prosthesis in Treatment of Trapeziometacarpal Joint Osteoarthritis: A Prospective Randomized Study. 治疗肘掌关节骨性关节炎的置换关节成形术与双杯活动假体:前瞻性随机研究
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-23 DOI: 10.1177/15589447231185584
Matteo Guzzini, Leopoldo Arioli, Alessandro Annibaldi, Stefano Pecchia, Francesca Latini, Andrea Ferretti

Background: Osteoarthritis (OA) of the trapeziometacarpal (TMC) joint is a common cause of pain and functional disability of the hand and is the second most frequent site in the hand of OA. This prospective randomized study analyses and compares the outcomes and global assessment of 2 different surgical techniques for rhizarthrosis treatment: trapeziectomy with tendon interposition arthroplasty and total joint replacement with Touch® (KeriMedical; Geneva, Switzerland) TMC prosthesis.

Methods: The enrolled patients were randomly divided into 2 groups: group A included 71 patients (75 hands) treated with tendon interposition arthroplasty, while group B included 65 patients (72 hands) treated with total joint replacement. Clinical and radiological outcomes were collected before surgery and at 1, 3, 6, 12, and 24 months of follow-up.

Results: Although the values of all clinical tests performed during follow-up demonstrated statistically significant improvement over preoperative ones in both groups, patients treated with prosthesis showed faster improvement, especially in tests of strength and range of motion, which showed better results than patients treated with trapeziectomy and tendon interposition arthroplasty throughout the follow-up.

Conclusions: Our study suggests that joint replacement should be preferred to interposition arthroplasty as the treatment of rhizarthrosis, choosing the latter in case of prosthetic replacement complications or scaphoid-trapezium-trapezoid OA.

背景:斜方肌-掌(TMC)关节骨关节炎(OA)是手部疼痛和功能障碍的常见原因,也是手部 OA 的第二大常见部位。这项前瞻性随机研究分析并比较了两种不同的根性关节炎手术治疗方法的疗效和总体评估:梯形关节切除术加肌腱间置关节成形术和使用Touch®(KeriMedical;瑞士日内瓦)TMC假体的全关节置换术:入组患者随机分为两组:A 组包括 71 名患者(75 只手),采用肌腱间置关节成形术;B 组包括 65 名患者(72 只手),采用全关节置换术。在手术前和随访 1、3、6、12 和 24 个月时收集临床和放射学结果:结果:虽然两组患者在随访期间进行的所有临床测试的数值都比术前有了统计学意义上的显著改善,但接受假体治疗的患者改善得更快,尤其是在力量和活动范围测试方面,在整个随访期间都比接受梯形切除术和肌腱置换关节置换术的患者效果更好:我们的研究表明,在治疗根性关节炎时,关节置换术应优于肌腱间置关节成形术,如果出现假体置换并发症或肩胛骨-梯形肌-梯形肌OA,则应选择后者。
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引用次数: 0
Upper Extremity Wood Saw Injuries: Experience at a Single Level 1 Trauma Center. 上肢木锯伤:一家一级创伤中心的经验。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-05-24 DOI: 10.1177/15589447231174044
Matthew T Hoffa, Alex Benedick, Jeffrey S Simske, Heather A Vallier

Background: Saw injuries are common, with more 75 000 occurring each year in the United States alone. While these injuries occur frequently, management strategies are not universally agreed upon, and data regarding outcomes and complications are lacking. We propose to provide a comprehensive picture of upper extremity saw injury patterns, management strategies, complications, and outcomes.

Methods: Patients presenting to a single level 1 trauma center between 2012 and2019 with upper extremity laceration, crush, or amputation were identified. In all, 10 721 patients were reviewed, and those without wood saw injuries were excluded. Patient demographic information, injury details, management strategy, and outcomes were collected.

Results: In all, 283 upper extremity wood saw injuries were analyzed. Injuries most commonly affected the fingers (92.2%), and the frequencies of simple lacerations and complicated injuries were nearly identical. The table saw was the most commonly implicated saw (48%) with more than half of the injuries being complicated, the most common being bone injury. Most patients were treated nonsurgically (81.3%), with the majority undergoing wound care in the emergency department followed by home antibiotics (68.2%). Subsequent complications were exceedingly rare (4.2%), with wound infection occurring in 5 patients. Amputations occurred in 19.4% of patients, leading to permanent functional impairment.

Conclusions: Wood saw injuries are common, generating functional and financial burden. While injuries range in severity, management can typically be conducted within the emergency department with local wound care and outpatient oral antibiotics. Injury complications and long-term issues are rare. Ongoing efforts to promote saw safety are required to minimize the burden of these injuries.

背景:锯伤很常见,仅在美国每年就有 75 000 多例。虽然这些损伤经常发生,但管理策略并未得到普遍认同,也缺乏有关结果和并发症的数据。我们建议全面了解上肢锯伤的模式、处理策略、并发症和结果:方法:对 2012 年至 2019 年期间在一家一级创伤中心就诊的上肢撕裂伤、挤压伤或截肢的患者进行鉴定。共审查了 10 721 例患者,排除了无木锯锯伤的患者。收集了患者的人口统计学信息、损伤细节、处理策略和结果:结果:共分析了 283 例上肢木锯伤患者。最常见的受伤部位是手指(92.2%),单纯撕裂伤和复杂伤的频率几乎相同。台锯是最常见的锯子(48%),半数以上的损伤为复杂性损伤,最常见的是骨损伤。大多数患者都接受了非手术治疗(81.3%),其中大部分人在急诊科接受了伤口护理,随后在家中接受了抗生素治疗(68.2%)。随后出现的并发症极为罕见(4.2%),5 名患者出现伤口感染。19.4%的患者发生截肢,导致永久性功能障碍:结论:木锯损伤很常见,会造成功能和经济负担。虽然受伤的严重程度不一,但通常可在急诊科进行局部伤口护理和门诊口服抗生素治疗。损伤并发症和长期问题很少见。要想最大限度地减轻这些伤害的负担,就必须不断努力促进锯木安全。
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引用次数: 0
Post-traumatic AV Fistula of the Hand Successfully Treated With Percutaneous Endovascular Laser Ablation: Report of a Case. 经皮血管内激光消融术成功治疗手部创伤后房室瘘:病例报告。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2024-01-10 DOI: 10.1177/15589447231221171
Marco Fresa, Laura Bruschi, Sarah Grognuz, Joachim Meuli, Laurent Wehrli, Lucia Mazzolai

Acquired arteriovenous fistula (AVF) in the hand can occur after trauma, fracture, or surgery. It is a rare condition, and only a few cases have been reported in the literature. Clinically they appear as palpable or painful lesions that persist long after the local hematoma has resolved. We report a case of a young patient presenting with long-standing and invalidating pain of the hand caused by a post-traumatic AVF, treated with percutaneous endovascular laser ablation.

手部获得性动静脉瘘(AVF)可能发生在创伤、骨折或手术之后。这是一种罕见的疾病,文献中仅报道过几例。临床表现为局部血肿消退后长期存在的可触及或疼痛的病变。我们报告了一例年轻患者的病例,该患者因外伤后动静脉瘘导致手部长期疼痛难忍,经皮血管内激光消融术对其进行了治疗。
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引用次数: 0
Spontaneous Rupture of the Extensor Pollicis Longus Tendon: A Systematic Review. 伸拇长肌腱自发性断裂:系统回顾。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-06-02 DOI: 10.1177/15589447231175513
Rachel C Lister, Henry C Bradford, Alex Joo, Catherine W Carr, Anna Delancy, Aparajit Naram, Douglas M Rothkopf, John V Shufflebarger

Background: Extensor pollicis longus (EPL) rupture and tenosynovitis of the third dorsal compartment is often described in association with a history of rheumatoid arthritis or in the setting of a distal radius fracture. However, the literature suggests multiple other potential factors that may lead to a seemingly spontaneous rupture.

Methods: We performed a systematic review following guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search consisted of headings and keywords related to tendon injuries, tendinopathy, hand surgery, tendon transfer, and injections, as published in reports and studies. Citations were screened by title and abstract against predetermined inclusion and exclusion criteria by 2 independent reviewers, with a third reviewer resolving discrepancies. To be eligible, articles had to meet the following inclusion criterion: describe cases of spontaneous EPL rupture or tenosynovitis of the third dorsal compartment. The exclusion criterion was any history of distal radius fracture or rheumatoid arthritis.

Results: We identified 29 articles that met the inclusion criterion.

Conclusions: A myriad of prodromal events or predisposing factors ultimately led to EPL rupture or tenosynovitis of the third compartment. Methods of reconstruction described included primary repair, tendon grafting, and tendon transfer techniques; all with generally good outcomes. These results highlight the inherent fragility of this tendon and support the historical recommendation for early release of the EPL tendon in the setting of tenosynovitis of the third dorsal compartment.

背景:背侧第三节伸肌(EPL)断裂和腱鞘炎通常与类风湿性关节炎病史或桡骨远端骨折有关。然而,文献表明还有其他多种潜在因素可能导致看似自发性的断裂:我们按照《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses)的指导原则进行了系统综述。检索包括与肌腱损伤、肌腱病、手部手术、肌腱转移和注射有关的标题和关键词,这些内容发表在报告和研究中。由两名独立审稿人根据预先确定的纳入和排除标准,通过标题和摘要对引文进行筛选,并由第三名审稿人解决差异问题。符合条件的文章必须满足以下纳入标准:描述自发性EPL断裂或第三背室腱鞘炎的病例。排除标准为任何桡骨远端骨折或类风湿性关节炎病史:结果:我们共发现了 29 篇符合纳入标准的文章:结论:无数的前驱事件或诱发因素最终导致了第三节EPL断裂或腱鞘炎。所描述的重建方法包括初次修复、肌腱移植和肌腱转移技术;所有方法的效果普遍良好。这些结果凸显了该肌腱固有的脆弱性,并支持在发生背侧第三室腱鞘炎时尽早松解 EPL 肌腱的历史性建议。
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引用次数: 0
How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb's Type) Birth Injuries. 在一家诊所实施 Sup-ER 方案如何改变了上臂丛神经(埃尔布氏型)产伤的手术模式。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-11-01 Epub Date: 2023-07-15 DOI: 10.1177/15589447231184896
Vanessa Choi Yin Wong, Darius Balumuka, Young Ji Tuen, Marija Bucevska, Rebecca Courtemanche, Kim Durlacher, Doria Bellows, Sally Hynes, Cynthia Verchere

Background: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.

Methods: The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed.

Results: Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function.

Conclusions: We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.

背景:对于患有上臂丛神经出生损伤(BPBI;C5、C6、±C7 根)的儿童,大多数诊所首先建议采用非手术治疗,然后对选定的患者进行初级和/或二级手术干预。自 2008 年以来,我们一直采用婴儿肩关节复位方案(上举-外旋 [Sup-ER]),旨在预防肩关节内旋挛缩及其对肩关节的潜在影响。本研究描述了本诊所目前对主要和次要程序干预(包括肉毒杆菌毒素)的选择、数量和时机,并将 Sup-ER 方案患者与历史对照组患者进行了比较:回顾性审查了 2001 年至 2018 年期间接受手术的所有上部 BPBI 患者的记录,并将其分为历史队列(2001-2007 年,n = 20)和近期队列(2008-2018 年,n = 23)。收集并分析了患者的人口统计学特征、手术类型和时间以及功能结果:结果:自2008年制定Sup-ER方案以来,臂丛神经探查和移植(BPEG)手术的数量减少了,而且在婴儿后期没有进行任何手术,因为神经转移是首选。肉毒杆菌毒素注射次数更多、时间更早。肌腱转移较少,术前适应症的功能水平较高:结论:目前,BPEG 手术的适应症总体上有所减少。结论:目前,我们发现 BPEG 手术的适应症总体上有所减少。在 3 个月年龄组之后,如果需要进行神经手术,更多的适应症是直接神经转移,而不是 BPEG 手术。肩部肌腱转移率有所下降。肱骨截骨手术在我们最近的研究小组中没有出现。在两组患者中,肌腱转移中的盂状截骨术都很少见。
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引用次数: 0
Targeted Muscle Reinnervation Compared to Standard Peripheral Nerve Management Following Amputation: A Systematic Review and Meta-Analysis. 截肢后靶向肌肉再神经支配与标准外周神经管理的比较:系统回顾与元分析》。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-29 DOI: 10.1177/15589447241284811
Alexis J Zimbulis, Vincent V G An, Michael Symes, Liron S Duraku, R Glenn Gaston, Kyle R Eberlin, Brahman Sivakumar

Background: Chronic pain remains a significant challenge for individuals following limb amputation, with incidence of painful neuromas, phantom limb pain (PLP), and residual limb pain (RLP). Targeted muscle reinnervation (TMR) is a surgical technique designed to restore motor control information lost during amputation by redirecting residual nerves to new muscle targets. This systematic review and meta-analysis aims to compare patient-reported and functional outcomes following amputation with either TMR or standard neurological treatment (SNT). The study also includes an examination of primary versus secondary TMR and explores outcomes in highly comorbid patient populations.

Methods: A search of central databases was performed, and meta-analysis was completed on extracted data where possible.

Results: Eleven studies were identified. Results indicate a significant reduction in PLP and RLP in patients undergoing TMR compared to SNT using various pain scores. TMR also demonstrates improved functional outcomes and decreased opioid use. Furthermore, results indicated patients who underwent TMR at the time of amputation (primary TMR) had improved pain scores compared with those who had TMR performed later (secondary TMR).

Conclusions: The review emphasizes the benefits of TMR as a valuable surgical adjunct for amputee patients, while also highlighting the need for further research, especially in comorbid populations.

背景:慢性疼痛仍然是截肢后患者面临的一大挑战,疼痛性神经瘤、幻肢痛(PLP)和残肢痛(RLP)的发病率很高。靶向肌肉神经支配(TMR)是一种外科技术,旨在通过将残余神经重新定向到新的肌肉靶点来恢复截肢期间丢失的运动控制信息。本系统综述和荟萃分析旨在比较患者报告的截肢后的功能结果与 TMR 或标准神经治疗 (SNT) 的结果。研究还包括对初级 TMR 和二级 TMR 的检查,并探讨高度合并症患者的治疗效果:方法:对中央数据库进行检索,并在可能的情况下对提取的数据进行荟萃分析:结果:共发现 11 项研究。结果表明,与使用各种疼痛评分的 SNT 相比,接受 TMR 的患者 PLP 和 RLP 明显降低。TMR 还改善了功能性结果,减少了阿片类药物的使用。此外,研究结果表明,在截肢时接受 TMR(初次 TMR)的患者与后来接受 TMR(二次 TMR)的患者相比,疼痛评分有所改善:综述强调了颞下颌关节置换术作为截肢患者重要手术辅助手段的益处,同时也强调了进一步研究的必要性,尤其是对合并症人群的研究。
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引用次数: 0
Anatomy of Lister's Tubercle: Implications for Volar Locked Plating of the Distal Radius. 李斯特结节的解剖:桡骨远端外侧锁定钢板的意义。
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-29 DOI: 10.1177/15589447241284783
Charlotte L E Laane, Floris V Raasveld, Huub H de Klerk, Daniel T Weigel, Jayanth S Pratap, Neal C Chen, Kyle R Eberlin

Background: Determining accurate intraoperative screw length in complex distal radius fractures may pose difficulties. With volar plate fixation, excessive screw length may result in extensor pollicis longus injury and this can be challenging to determine via intraoperative imaging. This study aims to identify the precise anatomic location and parameters of Lister's tubercle on the dorsal aspect of the radius.

Methods: The anatomy and location of Lister's tubercle was evaluated in 26 cadaveric arms, of which 27% were female, with a mean age of 73.6 years. Additionally, Lister's tubercle was evaluated on 198 computed tomography (CT) scans using a quantitative distal radius surface map. Median age was 28 years, and 28% of the patients were female.

Results: As measured in cadaveric arms, the mean Lister's tubercle length was 12.6 mm, and width was 5.4 mm. The distance from the radial styloid to the distal and proximal border of Lister's tubercle averaged 23.0 and 10.4 mm, respectively. Of the total distal radial width, Lister's tubercle begins 43% from the radial border and spans to 42% of the ulnar border, encompassing 16% of the entire width of the dorsal distal radius. On CT mapping, the distance between the peak of Lister's tubercle and the ulnar and radial border of the radius was 46% and 54%, respectively. Female sex was associated with a smaller distal radius width, but not with a smaller Lister's tubercle.

Conclusions: Knowledge of Lister's tubercle anatomy may assist in more precise screw placement in volar locked plating of distal radius fractures.

Level of evidence: IV-Therapeutic.

背景:在复杂的桡骨远端骨折中确定术中螺钉的准确长度可能会造成困难。在进行桡骨外侧钢板固定时,过长的螺钉长度可能会导致伸肌损伤,而通过术中成像来确定这一点具有挑战性。本研究旨在确定桡骨背侧李斯特结节的精确解剖位置和参数:方法:对 26 具尸体手臂的李斯特结节解剖结构和位置进行了评估,其中 27% 为女性,平均年龄为 73.6 岁。此外,还使用定量桡骨远端表面图在 198 例计算机断层扫描(CT)中对李斯特结节进行了评估。中位年龄为 28 岁,28% 的患者为女性:在尸体手臂上测量的平均李斯特结节长度为12.6毫米,宽度为5.4毫米。从桡骨系带到李斯特结节远端和近端边界的距离平均分别为23.0毫米和10.4毫米。在桡骨远端总宽度中,李斯特结节始于桡骨边界的43%,跨越尺骨边界的42%,占整个桡骨远端背侧宽度的16%。在CT图上,李斯特结节的峰值与桡骨尺侧和桡侧边界之间的距离分别为46%和54%。女性与桡骨远端宽度较小有关,但与李斯特结节较小无关:结论:了解李斯特结节的解剖结构有助于在桡骨远端骨折的外侧锁定钢板术中更精确地放置螺钉:IV-治疗
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引用次数: 0
Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia. 采用 WALANT 与 MAC 麻醉的内窥镜腕管松解术术中成本比较
IF 1.8 Q2 ORTHOPEDICS Pub Date : 2024-10-29 DOI: 10.1177/15589447241284791
Jenna M Godfrey, John Benda, Won Jin Choi, Jason D Tavakolian, Erin C Owen

Background: The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting.

Methods: This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR.

Results: Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile.

Conclusions: Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.

背景:内窥镜腕管松解术(ECTR)的成本历来比开放式腕管松解术(OCTR)高出很多。环境和麻醉技术决定了手部手术的成本;与医院相比,非住院手术中心(ASC)的成本更低,而局部麻醉技术比全身麻醉更节省成本。本研究的目的是比较在非卧床手术中心环境下进行的 ECTR 宽清醒局部麻醉技术(WALANT)和监测麻醉护理(MAC):本研究包括2019年1月至2021年12月期间在ASC进行的481例使用WALANT的ECTR和405例使用MAC的ECTR。利用之前报告的直接手术室成本、管理费用和材料成本,我们计算出了每项手术的最终成本。我们还报告了并发症发生率:术中转为 OCTR 和后期修正为 OCTR:结果:在 WALANT 下进行 ECTR 的术中时间最短(22 分钟),而在 MAC 下进行 ECTR 的术中时间最长(25 分钟)。在 WALANT 下进行 ECTR 的总成本为 1341.28 美元,而在 MAC 下进行 ECTR 的总成本为 1634.00 美元,前者最具成本效益。两种技术的并发症都很低:我们的术中流程、人员配置模式和 ASC 设置节省了成本,使 ECTR 成为经济上可行的选择。
{"title":"Intraoperative Cost Comparison of Endoscopic Carpal Tunnel Release With WALANT Versus MAC Anesthesia.","authors":"Jenna M Godfrey, John Benda, Won Jin Choi, Jason D Tavakolian, Erin C Owen","doi":"10.1177/15589447241284791","DOIUrl":"10.1177/15589447241284791","url":null,"abstract":"<p><strong>Background: </strong>The cost of endoscopic carpal tunnel release (ECTR) has historically been shown to be significantly higher than the cost of open carpal tunnel release (OCTR). Setting and anesthetic technique drive costs in hand surgery; ambulatory surgical center (ASC) settings demonstrate lower costs when compared to hospital-based settings and local-only anesthetic techniques demonstrate savings over general anesthesia. The purpose of this study is to compare wide awake local-only anesthesia technique (WALANT) to monitored anesthetic care (MAC) for ECTR performed in an ASC setting.</p><p><strong>Methods: </strong>This study includes 481 ECTR under WALANT and 405 ECTR under MAC, performed between January 2019 and December 2021 in an ASC. Utilizing previously reported direct operating room costs, overhead, and material costs, we calculated a final cost for each procedure. We also report our complication rates: intraoperative conversion to OCTR and late revision to OCTR.</p><p><strong>Results: </strong>Intraoperative times were shortest for ECTR performed under WALANT (22 min) versus ECTR under MAC (25 min). The total cost for ECTR under WALANT was most cost-effective at $1341.28 versus ECTR under MAC at $1634.00. Both techniques demonstrated a low complication profile.</p><p><strong>Conclusions: </strong>Our intraoperative process flow, staffing model, and ASC setting resulted in cost savings making ECTR an economically feasible option.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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