The Late Reduction of Carpal Dislocations

1992 ◽  
Vol 17 (2) ◽  
pp. 137-139 ◽  
Author(s):  
I. G. C. WEIR
Keyword(s):  
Surgical Treatment ◽  
Open Reduction ◽  
Late Presentation ◽  
Range Of Movement ◽  
Manual Work ◽  
X Ray ◽  
Radial Styloid ◽  
Reasonable Choice

Five cases are reported in which open reduction of a lunate or peri-lunar dislocation was carried out after a delay of two weeks to six months. Results were poor in terms of range of movement and X-ray appearance, but function was surprisingly good, all patients returning to normal activities including heavy manual work. One patient later underwent excision of the radial styloid with an avascular scaphoid fragment; this apart, there were no requests for further surgical treatment. Open reduction remains a reasonable choice in the treatment of late presentation of lunate and perilunar dislocation.

Bennett’s Fracture Combined with Fracture of the Trapezium

1993 ◽  
Vol 18 (4) ◽  
pp. 523-526 ◽  
Author(s):  
M. GARCIA-ELIAS ◽  
A. HENRÍQUEZ-LLUCH ◽  
P. ROSSIGNANI ◽  
P. FERNANDEZ DE RETANA ◽  
J. OROVIO DE ELÍZAGA
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Carpometacarpal Joint ◽  
Range Of Movement ◽  
Manual Work ◽  
Radiological Appearance ◽  
Bennett’S Fracture ◽  
First Carpometacarpal Joint

Three cases are reported in which open reduction and internal fixation were required to stabilize an unstable first carpometacarpal joint with simultaneous fracture of the trapezium and Bennett’s fracture. The results were good in terms of range of movement and radiological appearance, all of them returning to normal activities, including heavy manual work.

Drilling and plombage (core decompression) of a femoral head avascular necrosis

2010 ◽  
Vol 19 (01) ◽  
pp. 36-39 ◽  
Author(s):  
P. Chládek ◽  
V. Havlas ◽  
T. Trc
Keyword(s):  
Surgical Treatment ◽  
Femoral Head ◽  
Core Decompression ◽  
Effective Treatment Option ◽  
Simple Method ◽  
X Ray ◽  
Large Femoral Head ◽  
Press Fit ◽  
Round Shape ◽  
Late Stages

SummaryThe treatment of femoral head necrosis of adults is still rather problematic. Conservative treatment has been reported relatively unsuccessful and surgical treatment does not show convincing results either. The most effective seems to be a surgical treatment in early stages of the disease, however, the diagnosis still remains relatively complicated. For the late stages (2B and above) the most effective treatment option is represented by core decompression and vascular grafting. However, drilling and plombage (especially when using press-fit technique) seems to be successful, although not excellent. The authors describe their own method of drilling and plombage of the necrotic zone of the femoral head in 41 patients with X-ray detected necrotic changes of the femoral head. The pain measured by VAS was seen to decrease after surgery in all patients significantly. The Jacobs score was also observed to have increased (from fair to good outcome). We have not observed any large femoral head collapse after surgery, moreover, in some cases an improvement of the round shape of the femoral head was seen. It is important to mention that in all cases femoral heads with existing necrotic changes (flattening or collapse) were treated. Although the clinical improvement after surgery was not significantly high, the method we describe is a safe and simple method of diminishing pain in attempt to prepare the femoral head for further treatment in a future, without significant restriction of the indication due to necrosis (osteochondroplasty, resurfacing, THR).

Surgery of the Spastic Hand in Cerebral Palsy

1998 ◽  
Vol 23 (3) ◽  
pp. 334-339 ◽  
Author(s):  
L. B. DAHLIN ◽  
Y. KOMOTO-TUFVESSON ◽  
S. SÄLGEBACK
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Upper Limb ◽  
The Other ◽  
Surgical Reconstruction ◽  
Range Of Movement ◽  
Striking Finding ◽  
Hemiplegic Cerebral Palsy

Thirty-six patients with hemiplegic cerebral palsy had surgical treatment for the upper limb and were followed up for 18 months postoperatively. Various operations were done. A striking finding was a significant improvement of stereognosis (ability to describe and recognize objects without vision). Most patients had improvement in different functional grasps following surgical reconstruction. Range of movement in the forearm and wrist also increased in most patients. The thumb-in-palm deformity was completely corrected in 31 of the patients and improved in the other five. Most patients had some or all of their expectations of the procedure fulfilled.

Treatment of Phalangeal Fractures by Tension Band Wiring

2001 ◽  
Vol 26 (1) ◽  
pp. 50-52 ◽  
Author(s):  
Y. SAFOURY
Keyword(s):  
Retrospective Study ◽  
Open Reduction ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Range Of Movement ◽  
Intraarticular Fractures ◽  
Phalangeal Fractures

This retrospective study assessed the outcomes of 30 patients with phalangeal fractures which were treated by open reduction and tension band wiring. Oblique, transverse and comminuted extraarticular fractures, as well as intraarticular fractures, were treated with this technique and they all united in about 8 weeks. There were no significant complications. At a mean follow-up period of 2.3 years, the active range of movement of the involved fingers was excellent in 17, and good in 13 instances. There were no fair or poor results.

scholarly journals Antegrade X-ray surgical interventions in patients with choledocholithiasis in case of failed endoscopic procedures

2019 ◽  
Vol 24 (2) ◽  
pp. 48-59
Author(s):  
O. I. Okhotnikov ◽  
M. V. Yakovleva ◽  
S. N. Grigoriev ◽  
V. I. Pakhomov ◽  
N. I. Shevchenko ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Postoperative Mortality ◽  
Endoscopic Papillotomy ◽  
X Ray ◽  
Endoscopic Procedures ◽  
Rendezvous Technique ◽  
Antegrade Approach ◽  
The Common

Objective. To analyze safety and efficacy of X-ray surgical treatment of choledocholithiasis in case of failed endoscopic procedures. Material and methods. A retrospective analysis included 195 patients with choledocholithiasis who underwent X-ray surgical treatment. Primary X-ray surgical intervention was antegrade cholangiostomy. Data of antegrade cholangiography were used to determine type of endobiliary intervention. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction, balloon dislocation of stones of the common bile duct into duodenum or jejunum, lithoextraction using rendezvous technique after endoscopic papillotomy through transpapillary drainage tube or a wire were applied. Results. Puncture and drainage of non-dilated bile ducts were successfully performed in 30 (15.4%) patients. There were 212 procedires of cholangiostomy in 195 patients including redo interventions. Complications after cholangiostomy were absent in 92.9% of cases. Minor complications occurred in 7.1% of cases. Antegrade mechanical and pneumatic choledocholithotripsy and lithoextraction was performed in 118 (98.3%) patients. Balloon dislocation of stones of the common bile duct into duodenum was applied in 52 (81.3%) patients. Lithoextraction using rendezvous technique after previous endoscopic papillosphincterotomy was performed in 12 (60%) patients. Six patients underwent transpapillary external-internal drainage of common bile duct. Five patients had stricture of biliodigestive anastomosis complicated by cholelithiasis. Lithotripsy and lithoextraction through antegrade approach or dislocation of stones into jejunum after previous balloon dilatation were performed in these patients. Postoperative mortality was 1.5%. Minimally invasive techniques were absolutely effective for choledocholithiasis in 187 (98.9%) patients. Conclusion. Antegrade X-ray surgical management is effective and safe in patients with choledocholithiasis and unsuccessful previous endoscopic procedures. Integral efficiency of antegrade management of cholelithiasis was 88.8%.

scholarly journals Comparison of Conservative and Operative Treatment of Jones Fracture

2019 ◽  
Author(s):  
Jiri Demel ◽  
Ladislav Planka ◽  
Radek Stichhauer ◽  
Leopold Pleva
Keyword(s):  
Surgical Treatment ◽  
Fracture Healing ◽  
Conservative Therapy ◽  
Aofas Score ◽  
X Ray ◽  
Jones Fracture ◽  
Conservative And Operative Treatment ◽  
O 15 ◽  
K 12 ◽  
Type Of Fracture

Abstract Background: A Jones fracture is a transverse fracture of the V. metatarsal bone, without significant dislocation in the diaphysis junction and metaphyseal metaphysis. This type of fracture is usually associated with a minimal injury mechanism, and is characterized with minimal swelling, absence of hematoma and prolonged healing. The aim of the presented study was to compare the surgical and conservative therapy of Jones fracture. The study was registered in the www.clinicaltrials.gov database, under the ClinicalTrials.gov ID: NCT04037540 on 27th July 2019. Methods: A total of 27 study subjects were randomized into two groups – Conservative (K): 12, and Operational (O): 15. The study subjects were followed after 6 and 12 weeks using X-ray and the American Orthopedic Foot and Ankle Score (AOFAS). In the absence of X-ray signs of healing and low AOFAS score in Group K, treatment was considered unsuccessful and the patient was indicated for surgical treatment. Results: Five patients in Group K showed no signs of healing on X-ray after 12 to 6 weeks. These patients also manifested poor AOFAS scores and were indicated for surgical treatment and excluded from the study. Fracture failure was observed in seven patients. Their AOFAS scores were at the least satisfactory and, the patients continued in conservative therapy. After 12 weeks, 6 patients manifested fracture healing on X-ray and the AOFAS score of 100. In one patient who refused surgery, the fracture was not healed after 12 weeks. In Group O, seven patients achieved fracture healing on X-ray after 6 weeks, 8 patients did not show fracture healing. The average AOFAS score after 6 weeks was 97 (excellent). After 12 months, 13 patients showed findings of fracture healing on X-ray. The average AOFAS score was 100 points (maximum). Conclusions: The results of the study show that 1) Surgical treatment leads to significantly faster signs of healing on X-ray than the conservative one 2) After six weeks of surgery, 93% (14 out of 15) of patients are able to fully load the limb. Keywords: Jones - Fracture - AOFAS - Herbert screw Unique protocol ID: FNO-KUCH-01-Jones

Anterior diaphragmatic hernias in children: long-term surgical outcomes

2021 ◽  
Vol 16 (3) ◽  
pp. 7-15
Author(s):  
D.A. Morozov ◽  
◽  
D.V. Khaspekov ◽  
E.A. Okulov ◽  
V.G. Masevkin ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Diaphragmatic Hernia ◽  
Complex Analysis ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
X Ray ◽  
Hernial Sac ◽  
Chest X Ray ◽  
Diaphragmatic Hernias

Anterior diaphragmatic hernia (ADH) is a rare congenital pathology that occurs in children with a frequency of 1:4800 (1–6% of all congenital diaphragmatic hernias). There are many controversial aspects in the surgical treatment of patients with ADH: the choice of surgical approach, the method of diaphragmatic repair and the feasibility of excision of the hernial sac. Objective. To conduct a comparative analysis of the surgical treatment of patients with ADH in different clinics, assessing longterm outcomes. Patients and methods. The medical records of 7 children with ADH who underwent surgical repair in different clinics (in time period from 2009 to 2019) were retrospecively reviewed. Evaluating the long-term results of ADH repair was made by telephone and online surveys of the parents of patients and by outpatient examination of children (chest x-ray in two projections). Results. In a ten-year period, 7 patients (4 boys and 3 girls) were operated on with a diagnosis of “anterior diaphragmatic hernia” at the age of 3 months to 12 years. In most children, a hernia was discovered accidentally by chest x-ray. Laparoscopic correction was performed in 5 (71%) cases, thoracoscopic correction – in 2 cases (29%). The main difference in surgical tactics in ADH patients was the manipulation with the hernial sac – the hernial sac was excised in 4 (57%) patients, but it was left in three cases (43%). The defect closure was performed by “full-thickness” separated sutures that fix the diaphragm to the anterior abdominal wall during laparoscopy (5) and to the chest tissue during thoracoscopy (2); in some cases, additional fixation to the rib (4) was performed. Sutures were tied extracorporeally and buried in the subcutaneous layer in 6 (86%) patients. Average follow-up was 7 years. While evaluating long-term outcomes no ADH recurrence were found. Conclusions. There are still many controversial aspects in the surgical treatment of ADH patients. In our opinion, multicenter studies with complex analysis of long-term results are required to standardize the surgical treatment of such patients. Key words: anterior diaphragmatic hernia, Larrey hernia, long-term outcomes, Morgani hernia

Observations on Digestion in the Ruminant

1932 ◽  
Vol 9 (4) ◽  
pp. 409-426
Author(s):  
H. E. MAGEE
Keyword(s):  
Blood Sugar ◽  
Circular Muscle ◽  
Percentage Increase ◽  
X Rays ◽  
Rapid Rate ◽  
Range Of Movement ◽  
Heavy Particles ◽  
X Ray ◽  
Dorsal Sac ◽  
Light Material

The results of experiments conducted on goats and sheep by X-rays and by blood-sugar analyses have been considered with the data of other observers and the deductions outlined below have been made. Ingesta, whether liquid or solid, first enter the reticulum and rumen. Heavy matter lodges in the former and light material may enter the same cavity or the rumen. Heavy particles remain in the reticulum for several days until they are broken down, probably by maceration. Light particles move all through the reticulo-rumen at a rapid rate, but the range of movement is least in the posterior ruminal sac. The reticulo-rumen is a mixing and fermentation cavity. Mixing is caused by rhythmical waves of contraction which pass over the reticulum, dorsal sac, ventral sac and posterior sac of the rumen in this order at intervals of 40 to 80 sec., the whole cycle requiring 25 to 40 sec. Onward passage of ingesta from reticulo-rumen is probably due, chiefly to an aspiratory act on the part of the omasum, the leaves of which filter off coarse materials and, by alternating contractions, grind them, while the contraction of the viscus as a whole squeezes the fluid and fine materials into the abomasum. The fundus of the abomasum shows no gross movements, but maintains a steady pressure on its contents, and thus drives them into the pylorus which expels them by peristalsis into the duodenum. Distension of the abomasum probably prevents its overfilling by reflexly inhibiting the movements of the fore-stomachs. The essential factors causing the rejection of the food mass in rumination are (I) thoracic negative pressure produced by sudden descent of the diaphragm and closure of the glottis, (2) relaxation of the circular muscle of the cardia and its dragging forwards by extension of the head and contraction of the longitudinal oesophageal muscle, (3) contraction of the dorsal ruminal sac. A reticular contraction precedes rejection, and swallowing of the remasticated bolus just precedes the succeeding reticular contraction. The fore-stomachs attain adult form at about the 7 month. The vagus is motor and the splanchnics inhibitory to the fore-stomachs. The fore-stomachs contain food after 7 days' starvation. The fasting blood sugar varies from 63 to 86 mg. per 100 c.c., and it rises steadily from the 40th to the 169th hour of fasting. The blood sugar rises slightly but very variably after carbohydrate meals. The inconstancy is related to the X-ray findings, which showed that barium meals may remain in the reticulo-rumen for 60 min. or more, or may pass into the omasum and abomasum within 5 min. after ingestion. The percentage increase in blood sugar after carbohydrate meals is greater in fasted than in non-fasted animals.

Treatment of gynecological bleeding

1934 ◽  
Vol 30 (6) ◽  
pp. 636-636
Author(s):  
Н. Runge
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
General Condition ◽  
The Body ◽  
Foreign Protein ◽  
Second Phase ◽  
X Ray

The author recommends the following method of treatment of such bleeding: 1) at strong periods-rest, means reducing the uterus; treatment of existing diseases of organs in the interval of bleeding by infections of nonspecific means (calcium, foreign protein, own blood and serum); application of follicular hormone at hypoplasia of uterus on the basis of insufficiency of ovary; X-ray castration in women close to menopause in cases where strong monthly bleeding leads to anemia; 2) in case of frequent periods - to pay attention to the general condition of the body, in the absence of local and general changes treatment with hormones (in shortening of the second phase of the cycle - lute body hormone in the second half of the cycle, in hypoplastic uterus - follicular hormone) is indicated; 3) in bleeding on the basis of myoma- X-ray castration, if the bleeding led to anemia, the tumor is not larger than a child's head and the woman is over 45 years old; or surgical treatment; 4) in atypical bleeding-in cases of ascending endometritis, accompanied by severe inflammatory phenomena, fever a. recommends conservative treatment.

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