首页 > 最新文献

The Hand最新文献

英文 中文
Upper Extremity Surgery in Tetraplegia and the Online Information Void 四肢瘫痪的上肢手术与网络信息空白
Pub Date : 2019-10-16 DOI: 10.1177/1558944719878835
S. Zhong, Gabriella E Reed, L. Kalliainen
Background: People with tetraplegia lack awareness of, and subsequently underutilize, reconstructive surgery to improve upper extremity function. This is a topic of international discussion. To bridge the information gap, proposed mandates encourage providers to discuss surgical options with all tetraplegic patients. Outside of the clinical setting, little is known about information available to patients and caregivers—particularly online. The purpose of this study is to evaluate online content for surgical options for improved upper extremity function for people with tetraplegia. Methods: A sample of online content was generated using common search engines and 2 categories of key words and phrases, general and specific. Articles on the first 2 search pages were evaluated for content and audience. Results: A total of 76 different search results appeared on the first 2 pages using 8 unique search phrases. Of articles generated from general phrases, only 5% mentioned tendon or nerve transfers in tetraplegia. When more specific key search phrases were used, the number of lay articles increased to 71%. Conclusions: Based on initial results, general online information on the management of tetraplegia largely excludes discussions of upper limb reconstruction and the well-known benefits. Unless patients, their caregivers, and nonsurgical health care providers have baseline knowledge of tendon and/or nerve transfers, they are unlikely to obtain de novo awareness of surgical options with self-initiated searches. Thus, the challenge and opportunity is to revise the online dialogue to include upper extremity surgery as a fundamental tenet of tetraplegia care.
背景:四肢瘫痪患者对改善上肢功能的重建手术缺乏认识,随后也没有得到充分利用。这是一个国际讨论的话题。为了弥补信息差距,拟议的授权鼓励提供者与所有四肢瘫痪患者讨论手术选择。在临床环境之外,人们对患者和护理人员可获得的信息知之甚少,尤其是在网上。本研究的目的是评估改善四肢瘫痪患者上肢功能的手术选项的在线内容。方法:使用常用搜索引擎和2类关键词和短语(一般和特定)生成在线内容样本。对前2个搜索页面上的文章进行了内容和受众评估。结果:前两页共出现76个不同的搜索结果,使用了8个独特的搜索短语。在从一般短语中产生的文章中,只有5%提到四肢瘫痪时的肌腱或神经转移。当使用更具体的关键词搜索短语时,外行文章的数量增加到71%。结论:根据初步结果,关于四肢瘫痪治疗的一般在线信息在很大程度上排除了上肢重建和众所周知的益处的讨论。除非患者、他们的护理人员和非手术医疗保健提供者对肌腱和/或神经移植有基本了解,否则他们不太可能通过自我启动的搜索获得对手术选择的新认识。因此,挑战和机会是修改在线对话,将上肢手术纳入四肢瘫痪护理的基本原则。
{"title":"Upper Extremity Surgery in Tetraplegia and the Online Information Void","authors":"S. Zhong, Gabriella E Reed, L. Kalliainen","doi":"10.1177/1558944719878835","DOIUrl":"https://doi.org/10.1177/1558944719878835","url":null,"abstract":"Background: People with tetraplegia lack awareness of, and subsequently underutilize, reconstructive surgery to improve upper extremity function. This is a topic of international discussion. To bridge the information gap, proposed mandates encourage providers to discuss surgical options with all tetraplegic patients. Outside of the clinical setting, little is known about information available to patients and caregivers—particularly online. The purpose of this study is to evaluate online content for surgical options for improved upper extremity function for people with tetraplegia. Methods: A sample of online content was generated using common search engines and 2 categories of key words and phrases, general and specific. Articles on the first 2 search pages were evaluated for content and audience. Results: A total of 76 different search results appeared on the first 2 pages using 8 unique search phrases. Of articles generated from general phrases, only 5% mentioned tendon or nerve transfers in tetraplegia. When more specific key search phrases were used, the number of lay articles increased to 71%. Conclusions: Based on initial results, general online information on the management of tetraplegia largely excludes discussions of upper limb reconstruction and the well-known benefits. Unless patients, their caregivers, and nonsurgical health care providers have baseline knowledge of tendon and/or nerve transfers, they are unlikely to obtain de novo awareness of surgical options with self-initiated searches. Thus, the challenge and opportunity is to revise the online dialogue to include upper extremity surgery as a fundamental tenet of tetraplegia care.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"694 - 697"},"PeriodicalIF":0.0,"publicationDate":"2019-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719878835","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44590478","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}
引用次数: 5
Delayed Presentation of Seymour Fractures: A Single Institution Experience and Management Recommendations 西摩骨折的延迟表现:单一机构的经验和管理建议
Pub Date : 2019-10-09 DOI: 10.1177/1558944719878846
R. Samade, James S Lin, J. Popp, J. Samora
Background: Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. Methods: A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher’s exact test, with results reported as P-values (P), odds ratios (ORs), and 95% confidence intervals (CIs). Results: There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, P = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, P = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, P = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin (P = .039). Conclusions: Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.
背景:儿童西摩骨折在没有及时和适当治疗的情况下容易出现并发症。本研究探讨了延迟表现的西摩骨折的预后;具体来说,如果深部感染倾向于手术治疗,如果抗生素治疗能改善骨折愈合,如果口服克林霉素比口服头孢氨苄治疗失败更少。方法:对2009年至2017年迟发性西摩骨折(定义为损伤后24小时以上)患者进行单机构回顾性队列研究。收集的数据包括人口统计学、就诊时间、就诊时感染、手术治疗、抗生素使用和持续时间、骨折愈合和并发症。统计检验采用逻辑回归和Fisher精确检验,结果以P值(P)、优势比(ORs)和95%置信区间(ci)报告。结果:73例迟发性Seymour骨折患者,平均年龄11.1岁(标准差:2.9),男性56例(77%),中位发病时间为7天(四分位数间距:3-17)。入院时深部感染是手术干预的危险因素(OR = 34.4, P = 0.0001, CI, 5.5-217.2)。抗生素治疗可防止骨不连或延迟愈合(or = 0.11, P = 0.008, CI, 0.021-0.57)。抗生素治疗时间对不愈合或延迟愈合没有保护作用(or = 0.77, P = 0.306, CI, 0.37-1.3)。克林霉素的治疗失败率低于头孢氨苄(P = 0.039)。结论:深部感染是延迟表现的西摩骨折手术治疗的危险因素。克林霉素是治疗迟发性西摩骨折的较好抗生素。
{"title":"Delayed Presentation of Seymour Fractures: A Single Institution Experience and Management Recommendations","authors":"R. Samade, James S Lin, J. Popp, J. Samora","doi":"10.1177/1558944719878846","DOIUrl":"https://doi.org/10.1177/1558944719878846","url":null,"abstract":"Background: Seymour fractures in children are prone to complications without prompt and appropriate treatment. This study investigated outcomes of Seymour fractures with delayed presentations; specifically, if deep infection predisposed to operative treatment, if antibiotic administration improved fracture healing, and if oral clindamycin had fewer treatment failures than oral cephalexin. Methods: A single-institution retrospective cohort study was performed of patients with delayed Seymour fracture presentations (defined as greater than 24 hours post-injury) between 2009 and 2017. Data collected included demographics, time to presentation, infection on presentation, operative treatment, antibiotic use and duration, fracture union, and complications. Statistical testing used logistic regression and Fisher’s exact test, with results reported as P-values (P), odds ratios (ORs), and 95% confidence intervals (CIs). Results: There were 73 patients with delayed Seymour fracture presentations, with mean age of 11.1 years (standard deviation: 2.9), with 56 (77%) males, and median time to presentation of 7 days (interquartile range: 3-17). Deep infection on presentation was a risk factor for operative intervention (OR = 34.4, P = .0001, CI, 5.5-217.2). Antibiotic administration protected against the development of a nonunion or delayed union (OR = 0.11, P = .008, CI, 0.021-0.57). Time to antibiotics did not protect against nonunion or delayed union (OR = 0.77, P = .306, CI, 0.37-1.3). Clindamycin had fewer treatment failures than cephalexin (P = .039). Conclusions: Deep infection is a risk factor for operative treatment of Seymour fractures with delayed presentations. Clindamycin is a better antibiotic choice for Seymour fractures that present in delayed fashion.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"686 - 693"},"PeriodicalIF":0.0,"publicationDate":"2019-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719878846","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47059591","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}
引用次数: 6
Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint 拇指掌指关节弹性置换术的远期疗效
Pub Date : 2019-10-03 DOI: 10.1177/1558944719878841
C. Cefalu, P. Blazar, B. Simmons, Brandon E. Earp
Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.
背景:硅橡胶掌指关节置换术(SMPA)已被证明是治疗非拇指指终末期关节炎的一种持久选择,而融合是拇指掌指关节(MP)的主要手术。很少有研究评论拇指MP关节成形术的可行性。本研究报告了拇指SMPA术后的生存率和客观结果。方法:在一项机构审查委员会批准的回顾性研究中,我们确定了18名在三级学术中心由3名委员会认证的手外科医生进行拇指SMPA的患者。主要的结果指标是植入物存活率和术后并发症。次要结果测量是手臂、肩膀和手的快速残疾(quickDASH)评分、简短的密歇根手部问卷(bMHQ)和通过数字评定量表评定的术后疼痛。结果:最终随访时quickDASH和bMHQ的平均得分分别为35.6和70.6。最常见的短期并发症是临床畸形,其次是不稳定。唯一的长期并发症是一名既往无症状患者的植入物脱位。所有患者均报告疼痛减轻。3名患者需要翻修手术,2名患者需要持续不稳定,1名患者需要植入脱位。在5.8年的平均随访中,原发生存率为83%。结论:拇指SMPA是治疗终末期关节炎的可行选择。在我们的系列中,疼痛缓解是一致的。在那些报告持续症状或需要翻修的患者中,大多数患者有一个或多个目前文献中报道的失败的关键术前风险因素。需要更大的前瞻性系列来证明拇指SMPA与融合相比具有更好的寿命和功能结果。
{"title":"Long-term Outcomes of Silastic Arthroplasty of the Thumb Metacarpophalangeal Joint","authors":"C. Cefalu, P. Blazar, B. Simmons, Brandon E. Earp","doi":"10.1177/1558944719878841","DOIUrl":"https://doi.org/10.1177/1558944719878841","url":null,"abstract":"Background: Silastic metacarpophalangeal arthroplasty (SMPA) has proven to be a durable option for end-stage arthritis in the non-thumb digits, while fusion has been the mainstay procedure for the thumb metacarpophalangeal joint (MP). Few studies exist to comment on the viability of thumb MP arthroplasty. This study reports both survival and objective outcomes following SMPA of the thumb. Methods: In an institutional review board-approved retrospective study, we identified 18 patients who underwent thumb SMPA at a tertiary academic center by 3 board-certified hand surgeons. Primary outcome measures were implant survival and post-operative complications. Secondary outcomes measures were quick Disabilities of the Arm, Shoulder, and Hand (quickDASH) scores, brief Michigan Hand Questionnaire (bMHQ), and postoperative pain as rated by the numerical rating scale. Results: Mean quickDASH and bMHQ scores at final follow-up were 35.6 and 70.6, respectively. The most common short-term complication was clinical deformity, followed by instability. The sole long-term complication was an implant dislocation in a previously asymptomatic patient. All patients reported reduction in pain. Three patients were indicated for revision surgery, 2 for persistent instability, and 1 for implant dislocation. Primary survivorship was 83% at mean follow-up of 5.8 years. Conclusions: Thumb SMPA is a viable option for end-stage arthritis. Pain relief in our series was unanimous. Among those that reported persistent symptoms or required revision, a majority had one or more key preoperative risk factors for failure as currently reported in literature. Larger, prospective series are needed to prove superior longevity and functional outcomes of thumb SMPA versus fusion.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"632 - 637"},"PeriodicalIF":0.0,"publicationDate":"2019-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719878841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46893900","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}
引用次数: 0
A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size 不同无头压缩螺钉产生压缩力的力学比较及断裂间隙大小的影响
Pub Date : 2019-09-30 DOI: 10.1177/1558944719877890
A. Ilyas, Jonathan M. Mahoney, B. Bucklen
Background: There is evidence that interfragmentary fracture gap size may affect the compression achievable with a modern headless compression screw (HCS). This mechanical study compared the compression achieved by 3 commercial HCS systems through various fracture gaps: CAPTIVATE Headless (Globus Medical, Inc, Audubon, Pennsylvania), Synthes (DePuy Synthes, Westchester, Pennsylvania), and Acumed Acutrak 2 (Acumed LLC, Hillsboro, Oregon). Methods: Screws were inserted into a custom test fixture composed of polyurethane synthetic bone foam fragments, separated by a layer of easily compressible polyurethane foam simulating a fracture gap. Compression was measured after final insertion and countersinking. The effect of the interfragmentary fracture gap size on the compression generated was also investigated. Results: The CAPTIVATE Headless 3.0 mm screw (70.1 ± 5.7 N) and the Synthes 3.0 mm screw (64.9 ± 7.3 N) achieved similar compressive forces after final countersink. Similar comparisons were found for the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws, and the CAPTIVATE Headless 4.0 mm and Acutrak 2 Standard screws. The final compression of the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws was not significantly affected when the fracture gap was doubled from 2 to 4 mm, but was reduced significantly by 95.9% with the Acutrak 2 Micro screw. Conclusion: When comparing like-sized screws, the CAPTIVATE, Synthes, and Acutrak 2 HCS systems demonstrated similar potential compressive forces. However, compared with the CAPTIVATE Headless and Synthes HCS systems, which are inserted with a compression sleeve that is not gap distance–dependent, the Acutrak 2 HCS system demonstrated less compression when the simulated fracture gap size was increased to 4 mm.
背景:有证据表明,骨折间隙大小可能会影响现代无头加压螺钉(HCS)的加压效果。这项力学研究比较了3种商用HCS系统在不同骨折间隙中的压缩效果:CAPTIVATE Headless (Globus Medical, Inc, Audubon, Pennsylvania)、Synthes (DePuy Synthes, Westchester, Pennsylvania)和Acumed Acutrak 2 (Acumed LLC, Hillsboro, Oregon)。方法:将螺钉插入由聚氨酯合成骨泡沫碎片组成的定制测试夹具中,由一层易压缩的聚氨酯泡沫模拟骨折间隙隔开。在最终插入和反击后测量压缩。研究了破碎间隙大小对压缩强度的影响。结果:CAPTIVATE无头3.0 mm螺钉(70.1±5.7 N)与Synthes 3.0 mm螺钉(64.9±7.3 N)在最终沉头后获得相似的压缩力。在CAPTIVATE无头2.5 mm和Synthes 2.4 mm螺钉以及CAPTIVATE无头4.0 mm和Acutrak 2 Standard螺钉上发现了类似的比较。当骨折间隙从2到4 mm增加一倍时,CAPTIVATE Headless 2.5 mm和Synthes 2.4 mm螺钉的最终压缩性没有明显影响,但使用Acutrak 2 Micro螺钉时,最终压缩性显著降低了95.9%。结论:在比较相同尺寸的螺钉时,CAPTIVATE、Synthes和Acutrak 2 HCS系统显示出相似的潜在压缩力。然而,与CAPTIVATE Headless和Synthes HCS系统相比,当模拟裂缝间隙尺寸增加到4mm时,Acutrak 2 HCS系统显示出更少的压缩。CAPTIVATE Headless和Synthes HCS系统插入了一个与间隙距离无关的压缩套筒。
{"title":"A Mechanical Comparison of the Compressive Force Generated by Various Headless Compression Screws and the Impact of Fracture Gap Size","authors":"A. Ilyas, Jonathan M. Mahoney, B. Bucklen","doi":"10.1177/1558944719877890","DOIUrl":"https://doi.org/10.1177/1558944719877890","url":null,"abstract":"Background: There is evidence that interfragmentary fracture gap size may affect the compression achievable with a modern headless compression screw (HCS). This mechanical study compared the compression achieved by 3 commercial HCS systems through various fracture gaps: CAPTIVATE Headless (Globus Medical, Inc, Audubon, Pennsylvania), Synthes (DePuy Synthes, Westchester, Pennsylvania), and Acumed Acutrak 2 (Acumed LLC, Hillsboro, Oregon). Methods: Screws were inserted into a custom test fixture composed of polyurethane synthetic bone foam fragments, separated by a layer of easily compressible polyurethane foam simulating a fracture gap. Compression was measured after final insertion and countersinking. The effect of the interfragmentary fracture gap size on the compression generated was also investigated. Results: The CAPTIVATE Headless 3.0 mm screw (70.1 ± 5.7 N) and the Synthes 3.0 mm screw (64.9 ± 7.3 N) achieved similar compressive forces after final countersink. Similar comparisons were found for the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws, and the CAPTIVATE Headless 4.0 mm and Acutrak 2 Standard screws. The final compression of the CAPTIVATE Headless 2.5 mm and Synthes 2.4 mm screws was not significantly affected when the fracture gap was doubled from 2 to 4 mm, but was reduced significantly by 95.9% with the Acutrak 2 Micro screw. Conclusion: When comparing like-sized screws, the CAPTIVATE, Synthes, and Acutrak 2 HCS systems demonstrated similar potential compressive forces. However, compared with the CAPTIVATE Headless and Synthes HCS systems, which are inserted with a compression sleeve that is not gap distance–dependent, the Acutrak 2 HCS system demonstrated less compression when the simulated fracture gap size was increased to 4 mm.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"604 - 611"},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719877890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41442850","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}
引用次数: 3
Median Nerve Compression in the Forearm: A Clinical Diagnosis 前臂正中神经压迫的临床诊断
Pub Date : 2019-09-20 DOI: 10.1177/1558944719874137
M. El-Haj, Wei Ding, Ketan Sharma, C. Novak, Susan E. Mackinnon, J. Megan M. Patterson
Background: Median nerve entrapment in the forearm (MNEF) without motor paralysis is a challenging diagnosis. This retrospective study evaluated the clinical presentation, diagnostic studies, and outcomes following surgical decompression of MNEF. Methods: The study reviewed 147 patient medical charts following MNEF surgical decompression. With exclusion of patients with combined nerve entrapments (radial and ulnar), polyneuropathy, neurotmetic nerve injury, or median nerve motor palsy, the study sample included 27 patients. Data collected include: clinical presentation and pain, strength, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The study included 27 patients (mean follow-up = 7 months), and 13 patients had previous carpal tunnel release (CTR). Clinical presentation included pain (n = 27) (forearm, n = 22; median nerve innervated digits, n = 21; and palm, n = 21) and positive clinical tests (forearm scratch collapse test, n = 27; pain with compression over the flexor digitorum superficialis arch/pronator, n = 24; Tinel sign, n = 11). Positive electrodiagnostic studies were found for MNEF (n = 2) and carpal tunnel syndrome (n = 11). Primary CTR was performed in 10 patients and revision CTR in 7 patients. Postoperatively, there were significant (P < .05) improvements in strength, pain, quality of life, and DASH scores. Conclusions: The MNEF without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent forearm pain and median nerve symptoms (especially after CTR) should be evaluated for MNEF. Surgical decompression provides satisfactory outcomes.
背景:没有运动麻痹的前臂正中神经卡压(MNEF)是一个具有挑战性的诊断。这项回顾性研究评估了MNEF手术减压后的临床表现、诊断研究和结果。方法:本研究回顾了147例MNEF手术减压后的病历。研究样本包括27名患者,其中排除了合并神经卡陷(桡骨和尺骨)、多发性神经病、拟神经损伤或正中神经运动性麻痹的患者。收集的数据包括:临床表现和疼痛、力量、刺激性测试、功能结果以及手臂、肩膀和手部残疾(DASH)评分。结果:该研究包括27名患者(平均随访=7个月),13名患者既往有腕管松解症(CTR)。临床表现包括疼痛(n=27)(前臂,n=22;正中神经支配指,n=21;手掌,n=21)和阳性临床测试(前臂抓挠塌陷测试,n=27;指浅屈肌弓/旋前肌受压疼痛,n=24;Tinel征,n=11)。MNEF(n=2)和腕管综合征(n=11)的电诊断研究呈阳性。10例患者进行了初次CTR,7例患者进行翻修CTR。术后,力量、疼痛、生活质量和DASH评分均有显著改善(P<0.05)。结论:无运动麻痹的MNEF是一种由疼痛图、疼痛质量和刺激性测试支持的临床诊断。持续前臂疼痛和正中神经症状的患者(尤其是CTR后)应评估MNEF。手术减压提供了令人满意的结果。
{"title":"Median Nerve Compression in the Forearm: A Clinical Diagnosis","authors":"M. El-Haj, Wei Ding, Ketan Sharma, C. Novak, Susan E. Mackinnon, J. Megan M. Patterson","doi":"10.1177/1558944719874137","DOIUrl":"https://doi.org/10.1177/1558944719874137","url":null,"abstract":"Background: Median nerve entrapment in the forearm (MNEF) without motor paralysis is a challenging diagnosis. This retrospective study evaluated the clinical presentation, diagnostic studies, and outcomes following surgical decompression of MNEF. Methods: The study reviewed 147 patient medical charts following MNEF surgical decompression. With exclusion of patients with combined nerve entrapments (radial and ulnar), polyneuropathy, neurotmetic nerve injury, or median nerve motor palsy, the study sample included 27 patients. Data collected include: clinical presentation and pain, strength, provocative testing, functional outcomes, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: The study included 27 patients (mean follow-up = 7 months), and 13 patients had previous carpal tunnel release (CTR). Clinical presentation included pain (n = 27) (forearm, n = 22; median nerve innervated digits, n = 21; and palm, n = 21) and positive clinical tests (forearm scratch collapse test, n = 27; pain with compression over the flexor digitorum superficialis arch/pronator, n = 24; Tinel sign, n = 11). Positive electrodiagnostic studies were found for MNEF (n = 2) and carpal tunnel syndrome (n = 11). Primary CTR was performed in 10 patients and revision CTR in 7 patients. Postoperatively, there were significant (P < .05) improvements in strength, pain, quality of life, and DASH scores. Conclusions: The MNEF without motor paralysis is a clinical diagnosis supported by pain drawings, pain quality, and provocative tests. Patients with persistent forearm pain and median nerve symptoms (especially after CTR) should be evaluated for MNEF. Surgical decompression provides satisfactory outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"586 - 591"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719874137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49638474","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}
引用次数: 14
Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis 第一伸肌室的超声测量:确定超微创松解De Quervain腱鞘炎的横断界限
Pub Date : 2019-09-20 DOI: 10.1177/1558944719873435
Logan McCool, Brionn Tonkin, Danqing Guo, Danzhu Guo, Alexander Senk
Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.
背景:De Quervain综合征是第二常见的压迫性腱病。尽管之前已经研究过第一伸肌间隔(FEC)的长度,但没有文献报道短轴和长轴超声测量的比较研究。螺纹技术,或称郭技术,已被应用于腕管综合征、扳机指和腓浅压迫性神经病变。要执行此程序,准确识别横切的边界至关重要。方法:对21具新鲜冷冻尸体上肢进行超声检查,以确定FEC上伸肌支持带(ER)的长度。使用超声标记,在其近端至远端边缘以及从远端边缘至远端边缘的短轴和长轴上测量ER。然后将这些超声测量值与大体解剖测量值进行比较。结果:ER的短轴超声测量平均为22.53mm(95%置信区间[CI]=20.79-24.05mm)。ER的长轴超声测量值平均为15.65mm(95%CI=13.70-17.78mm)。通过大体解剖解剖,ER的平均长度为22.40mm(95%CI=21.15-23.51mm)。结论:短轴测量与大体解剖测量没有显著差异;然而,长轴明显低于大体解剖测量值。结果支持了短轴比长轴更准确的观点。
{"title":"Ultrasound Measurements of the First Extensor Compartment: Determining the Transection Limits for Ultra-minimally Invasive Release of De Quervain Tenosynovitis","authors":"Logan McCool, Brionn Tonkin, Danqing Guo, Danzhu Guo, Alexander Senk","doi":"10.1177/1558944719873435","DOIUrl":"https://doi.org/10.1177/1558944719873435","url":null,"abstract":"Background: De Quervain syndrome is the second most common compressive tendinopathy. Although the length of the first extensor compartment (FEC) has been studied previously, there is no documented reported comparison study of short-axis and long-axis sonographic measurements. The thread technique, or Guo Technique, has been applied to carpal tunnel syndrome, trigger finger, and superficial peroneal compressive neuropathy. To perform this procedure, it is critically important to accurately identify the boundaries for transection. Methods: Twenty-one fresh frozen cadaver upper extremities were examined under ultrasound to determine the length of the extensor retinaculum (ER) over the FEC. Using the sonographic landmarks, the ERs were measured in short axis and long axis over their proximal to distal margins and from the distal margins to the distal edges of the radial styloids. These sonographic measurements were then compared with gross anatomical measurements. Results: The short-axis sonographic measurement of the ER on average was 22.53 mm (95% confidence interval [CI] = 20.79-24.05 mm). The long-axis sonographic measurement of the ER on average was 15.65 mm (95% CI = 13.70-17.78 mm). The average length of the ER by gross anatomical dissection was 22.40 mm (95% CI = 21.15-23.51 mm). Conclusions: The short axis is not significantly different from the gross anatomical measurement; however, the long axis is significantly lower than the gross anatomical measurement. The results support the idea that the short axis is more accurate than the long axis.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"644 - 649"},"PeriodicalIF":0.0,"publicationDate":"2019-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873435","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47581049","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}
引用次数: 1
Missed Empathic Opportunities During Hand Surgery Office Visits 在手外科诊所就诊期间错过共情机会
Pub Date : 2019-09-17 DOI: 10.1177/1558944719873395
Bastiaan T. van Hoorn, M. Menendez, M. Mackert, E. Donovan, M. van Heijl, D. Ring
Background: Empathy (conveyance of an understanding of a patient’s situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = −0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.
背景:同理心(传达对患者情况、观点和感受的理解)加深了治疗联盟,并带来更好的健康结果。我们研究了在拜访手外科医生的患者中,移情机会和医生反应的频率和性质。我们还寻求了与患者提出的线索数量和外科医生错过的机会数量相关的患者特征。方法:在这项前瞻性队列研究中,我们招募了83名新的成年患者,他们在4个月的时间里访问了三分之一的手外科医生。所有就诊都进行了音频记录,并使用Levenson等人的模型对移情机会(患者引发的情绪或社会线索)和医生的反应进行了分类。在就诊前,患者完成了最新生命体征健康素养测试;3基于患者报告结果测量信息系统的问卷:上肢功能、疼痛干扰和抑郁问卷;以及社会人口调查。结果:70%的手外科办公室就诊都有移情机会。外科医生对大约一半的机会感同身受。健康素养有限且抑郁症状更严重的患者(相关性较小;r=-0.29)不太可能得到积极反应。对移情机会的反应不会影响访视时间。结论:手外科医生经常错过移情的机会。未来的研究可能会解决培训医生以解决移情机会对信任、依从性、满意度和结果的影响。
{"title":"Missed Empathic Opportunities During Hand Surgery Office Visits","authors":"Bastiaan T. van Hoorn, M. Menendez, M. Mackert, E. Donovan, M. van Heijl, D. Ring","doi":"10.1177/1558944719873395","DOIUrl":"https://doi.org/10.1177/1558944719873395","url":null,"abstract":"Background: Empathy (conveyance of an understanding of a patient’s situation, perspective, and feelings) deepens the therapeutic alliance and leads to better health outcomes. We studied the frequency and nature of empathic opportunities and physician responses in patients visiting a hand surgeon. We also sought patient characteristics associated with the number of patient-initiated-clues and missed opportunities by surgeons. Methods: For this prospective cohort study, we enrolled 83 new, adult patients visiting 1 of 3 hand surgeons during a period of 4 months. All visits were audio-recorded, and empathic opportunities (patient-initiated emotional or social clues) and physician responses were categorized using the model of Levenson et al. Before the visit, patients completed the Newest Vital Sign health literacy test; 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Upper-Extremity function, Pain Interference, and Depression questionnaires; and a sociodemographic survey. Results: Empathic opportunities were present in 70% of hand surgery office visits. Surgeons responded empathically to about half of the opportunities. Patients with limited health literacy and greater symptoms of depression (small correlation; r = −0.29) were less likely to receive a positive response. Response to an empathic opportunity did not affect visit duration. Conclusions: Hand surgeons often miss empathic opportunities. Future research might address the influence of training physicians to address empathic opportunities on trust, adherence, satisfaction, and outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"698 - 705"},"PeriodicalIF":0.0,"publicationDate":"2019-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873395","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47293811","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}
引用次数: 5
Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost 小儿外伤性截肢后手指再植:全国范围内的患者选择、结果和成本分析
Pub Date : 2019-09-14 DOI: 10.1177/1558944719873150
Neill Y. Li, J. Kleiner, A. Harris, A. Goodman, J. Katarincic
Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revision amputation and 1140 (36.9%) undergoing replantation. Younger patients, those with thumb injuries, females, and those covered under private insurance were significantly more likely to undergo replantation. Cost, length of stay, and in-hospital complications were significantly greater in replantation patients than in those who had undergone amputation. Following replantation, 237 patients (20.8%) underwent revision amputation and 209 (18.3%) underwent vascular revision, after which 58 required revision amputation. Risk of revision following replantation involved older patients, males, and procedures done recently. Conclusions: Pediatric patients who underwent replantation were significantly younger, female, had thumb injuries, and were covered by private insurance. Our findings demonstrate that in addition to injury factors, demographics play a significant role in the decision for finger replantation and its outcomes.
背景:创伤性手指截肢后再植的适应症在儿科人群中比在成人中更为自由,但儿科患者选择及其结果的描述尚待阐明。这项研究使用了一个国家儿科数据库来评估患者特征和再植损伤模式及其结果。方法:对2000年至2012年拇指和手指外伤性截肢的医疗成本与利用项目儿童住院患者数据库进行查询。参与者被分为接受再植的参与者和接受截肢的参与者。接受再植的患者被进一步分为需要翻修截肢和/或微血管翻修的患者。提取每位患者的年龄、性别、保险、受影响的数字、费用、住院时间和并发症。结果:3090例患者发生了创伤性手指截肢,其中1950例(63.1%)接受了翻修截肢,1140例(36.9%)接受了再植。年轻的患者、拇指受伤的患者、女性和私人保险覆盖的患者接受再植的可能性明显更大。再植患者的费用、住院时间和住院并发症明显高于截肢患者。再植后,237名患者(20.8%)接受了翻修截肢,209名患者(18.3%)接受血管翻修,其中58名患者需要翻修截肢。再植后翻修的风险涉及老年患者、男性和最近进行的手术。结论:接受再植的儿童患者年龄明显较小,为女性,拇指受伤,并有私人保险。我们的研究结果表明,除了损伤因素外,人口统计学在决定手指再植及其结果中也起着重要作用。
{"title":"Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection, Outcomes, and Cost","authors":"Neill Y. Li, J. Kleiner, A. Harris, A. Goodman, J. Katarincic","doi":"10.1177/1558944719873150","DOIUrl":"https://doi.org/10.1177/1558944719873150","url":null,"abstract":"Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revision amputation and 1140 (36.9%) undergoing replantation. Younger patients, those with thumb injuries, females, and those covered under private insurance were significantly more likely to undergo replantation. Cost, length of stay, and in-hospital complications were significantly greater in replantation patients than in those who had undergone amputation. Following replantation, 237 patients (20.8%) underwent revision amputation and 209 (18.3%) underwent vascular revision, after which 58 required revision amputation. Risk of revision following replantation involved older patients, males, and procedures done recently. Conclusions: Pediatric patients who underwent replantation were significantly younger, female, had thumb injuries, and were covered by private insurance. Our findings demonstrate that in addition to injury factors, demographics play a significant role in the decision for finger replantation and its outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"612 - 618"},"PeriodicalIF":0.0,"publicationDate":"2019-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45321260","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}
引用次数: 2
Does Societal Cost Information Affect Patient Decision-Making in Carpal Tunnel Syndrome? A Randomized Controlled Trial 社会成本信息是否影响腕管综合征患者的决策?随机对照试验
Pub Date : 2019-09-13 DOI: 10.1177/1558944719873399
Joost T. P. Kortlever, Thompson Zhuang, D. Ring, Lee M. Reichel, Gregg A. Vagner, R. Kamal
Background: Despite studies demonstrating the effects of out-of-pocket costs on decision-making, the effect of societal cost information on patient decision-making is unknown. Given the considerable societal impact of cost of care for carpal tunnel syndrome (CTS), providing societal cost data to patients with CTS could affect decision-making and provide a strategy for reducing national health care costs. Therefore, we assessed the following hypotheses: (1) there is no difference in treatment choice (surgery vs no surgery) in a hypothetical case of mild CTS between patients randomized to receive societal cost information compared with those who did not receive this information; (2) there are no factors (eg, sex, experience with a previous diagnosis of CTS, or receiving societal cost information) independently associated with the choice for surgery; and (3) there is no difference in attitudes toward health care costs between patients choosing surgery and those who did not. Methods: In this randomized controlled trial using a hypothetical scenario, we prospectively enrolled 184 new and return patients with a nontraumatic upper extremity diagnosis. We recorded patient demographics, treatment choice in the hypothetical case of mild CTS, and their attitudes toward health care costs. Results: Treatment choice was not affected by receiving societal cost information. None of the demographic or illness factors assessed were independently associated with the choice for surgery. Patients declining surgery felt more strongly that doctors should consider their out-of-pocket costs when making recommendations. Conclusions: Providing societal cost information does not seem to affect decision-making and may not reduce the overall health care costs. For patients with CTS, health policy could nudge toward better resource utilization and finding the best care pathways for nonoperative and invasive treatments.
背景:尽管研究证明了自付费用对决策的影响,但社会成本信息对患者决策的影响尚不清楚。鉴于腕管综合征(CTS)的医疗成本具有相当大的社会影响,为CTS患者提供社会成本数据可以影响决策并提供降低国家医疗成本的策略。因此,我们评估了以下假设:(1)在假设的轻度CTS病例中,随机接受社会成本信息的患者与未接受社会成本信息的患者相比,在治疗选择(手术与不手术)方面没有差异;(2)没有因素(如性别、既往CTS诊断经历或接受社会成本信息)与手术选择独立相关;(3)选择手术的患者与未选择手术的患者对医疗费用的态度没有差异。方法:在这个随机对照试验中,我们采用假设的场景,前瞻性地招募了184名非创伤性上肢诊断的新患者和复发患者。我们记录了患者的人口统计数据,假设轻度CTS病例的治疗选择,以及他们对医疗保健费用的态度。结果:治疗选择不受社会成本信息的影响。所评估的人口统计学或疾病因素均与手术选择无关。拒绝手术的患者更强烈地认为,医生在提出建议时应该考虑他们的自付费用。结论:提供社会成本信息似乎不会影响决策,也可能不会降低总体医疗保健成本。对于CTS患者,卫生政策可以推动更好地利用资源,并找到非手术和侵入性治疗的最佳护理途径。
{"title":"Does Societal Cost Information Affect Patient Decision-Making in Carpal Tunnel Syndrome? A Randomized Controlled Trial","authors":"Joost T. P. Kortlever, Thompson Zhuang, D. Ring, Lee M. Reichel, Gregg A. Vagner, R. Kamal","doi":"10.1177/1558944719873399","DOIUrl":"https://doi.org/10.1177/1558944719873399","url":null,"abstract":"Background: Despite studies demonstrating the effects of out-of-pocket costs on decision-making, the effect of societal cost information on patient decision-making is unknown. Given the considerable societal impact of cost of care for carpal tunnel syndrome (CTS), providing societal cost data to patients with CTS could affect decision-making and provide a strategy for reducing national health care costs. Therefore, we assessed the following hypotheses: (1) there is no difference in treatment choice (surgery vs no surgery) in a hypothetical case of mild CTS between patients randomized to receive societal cost information compared with those who did not receive this information; (2) there are no factors (eg, sex, experience with a previous diagnosis of CTS, or receiving societal cost information) independently associated with the choice for surgery; and (3) there is no difference in attitudes toward health care costs between patients choosing surgery and those who did not. Methods: In this randomized controlled trial using a hypothetical scenario, we prospectively enrolled 184 new and return patients with a nontraumatic upper extremity diagnosis. We recorded patient demographics, treatment choice in the hypothetical case of mild CTS, and their attitudes toward health care costs. Results: Treatment choice was not affected by receiving societal cost information. None of the demographic or illness factors assessed were independently associated with the choice for surgery. Patients declining surgery felt more strongly that doctors should consider their out-of-pocket costs when making recommendations. Conclusions: Providing societal cost information does not seem to affect decision-making and may not reduce the overall health care costs. For patients with CTS, health policy could nudge toward better resource utilization and finding the best care pathways for nonoperative and invasive treatments.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"439 - 446"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47701583","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}
引用次数: 0
Wrist-Spanning Fixation of Radiocarpal Dislocation: A Cadaveric Assessment of Ulnar Translation 腕跨固定桡腕关节脱位:尺骨平移的尸体评估
Pub Date : 2019-09-13 DOI: 10.1177/1558944719873148
A. Azad, Jihoon T. Choi, R. Fisch, A. Gipsman, Luke T. Nicholson, A. Ghiassi
Background: Radiocarpal dislocations represent a high-energy wrist injury that can occur with or without concomitant fractures about the wrist. Poor outcomes are often due to radiocarpal instability and secondary ulnar translation. The purpose of this cadaveric study is to determine if there is any difference in the radiographic parameters in a wrist dislocation model given the different location of distal fixation. Methods: Ten paired fresh cadaver upper extremities were fluoroscopically evaluated with posterior-anterior (PA) and lateral views. We created a radiocarpal dislocation model and applied a dorsal bridge plate to either the second or third metacarpal. Repeat PA and lateral fluoroscopic views were obtained for evaluation of radial inclination, radial height, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, scapholunate angle, radial rotation index, and four indices for ulnar translation (Taleisnik, Gilula, McMurtry, and Chamay). Results: Bridge plate application to the second metacarpal resulted in a significantly greater incidence of ulnar translation compared to the third metacarpal. Application to either metacarpal resulted in extension of the carpus relative to the radius. Conclusions: A more anatomic radiocarpal relationship was restored more often when distal fixation of the dorsal wrist-spanning bridge plate was applied to the third metacarpal. Further investigation is warranted to determine clinical relevance of these findings in conjunction with clinical and radiographic outcomes.
背景:放射性腕关节脱位是一种高能腕关节损伤,可伴有或不伴有腕关节骨折。结果不佳通常是由于桡腕不稳定和继发性尺骨平移。这项尸体研究的目的是确定在给定不同远端固定位置的情况下,腕关节脱位模型中的放射学参数是否存在任何差异。方法:对10对新鲜尸体上肢进行透视检查,分别从后-前(PA)和侧位观察。我们建立了桡腕关节脱位模型,并在第二或第三掌骨上应用背桥钢板。获得重复的PA和侧透视图,用于评估桡骨倾斜度、桡骨高度、掌侧倾斜、尺骨变异、桡侧角度、桡侧腕关节角度、舟侧角度、桡骨旋转指数和尺骨平移的四个指数(Taleisnik、Gilula、McMurtry和Chamay)。结果:与第三掌骨相比,第二掌骨桥接板的尺骨平移发生率明显更高。应用于任一掌骨导致腕骨相对于桡骨的延伸。结论:当腕背跨桥钢板远端固定在第三掌骨上时,更经常地恢复更解剖的桡腕关系。有必要进行进一步的研究,以确定这些发现与临床和放射学结果的临床相关性。
{"title":"Wrist-Spanning Fixation of Radiocarpal Dislocation: A Cadaveric Assessment of Ulnar Translation","authors":"A. Azad, Jihoon T. Choi, R. Fisch, A. Gipsman, Luke T. Nicholson, A. Ghiassi","doi":"10.1177/1558944719873148","DOIUrl":"https://doi.org/10.1177/1558944719873148","url":null,"abstract":"Background: Radiocarpal dislocations represent a high-energy wrist injury that can occur with or without concomitant fractures about the wrist. Poor outcomes are often due to radiocarpal instability and secondary ulnar translation. The purpose of this cadaveric study is to determine if there is any difference in the radiographic parameters in a wrist dislocation model given the different location of distal fixation. Methods: Ten paired fresh cadaver upper extremities were fluoroscopically evaluated with posterior-anterior (PA) and lateral views. We created a radiocarpal dislocation model and applied a dorsal bridge plate to either the second or third metacarpal. Repeat PA and lateral fluoroscopic views were obtained for evaluation of radial inclination, radial height, volar tilt, ulnar variance, radiolunate angle, radioscaphoid angle, scapholunate angle, radial rotation index, and four indices for ulnar translation (Taleisnik, Gilula, McMurtry, and Chamay). Results: Bridge plate application to the second metacarpal resulted in a significantly greater incidence of ulnar translation compared to the third metacarpal. Application to either metacarpal resulted in extension of the carpus relative to the radius. Conclusions: A more anatomic radiocarpal relationship was restored more often when distal fixation of the dorsal wrist-spanning bridge plate was applied to the third metacarpal. Further investigation is warranted to determine clinical relevance of these findings in conjunction with clinical and radiographic outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"482 - 490"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873148","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45712875","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}
引用次数: 5
期刊
The Hand
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1