scholarly journals The Uncommon Trapezium Fracture: A Case Series

2019 ◽  
Vol 09 (01) ◽  
pp. 063-070
Author(s):  
S. R. Beekhuizen ◽  
C. R. Quispel ◽  
J. Jasper ◽  
R. L. M. Deijkers

Abstract Background Isolated trapezium fractures are rare and account for only 1 to 5% of all carpal fractures but are still the third most common carpal fracture. Trapezium fractures are hard to detect and easily missed on standard radiographs. Trapezium fractures can be treated conservatively, as well as operatively, the best treatment is still debatable. Damage of the joint surface between the trapezium and the base of the first metacarpal or scaphoid could cause pain and restriction of movements. Therefore, it is important to diagnose and treat the fracture at early stage, so that articular congruence is guaranteed. Case description We present four cases of the uncommon trapezium fracture. All four cases are conservatively treated with good results, there was no need for operative treatment in all the cases. Literature review The literature describes the possibility to use fixation techniques, only when it is not possible to reduce the displaced fracture or the residual articular step-off is too high a fixation technique should be used. Clinical relevance Primarily, we would recommend navicular cast immobilization for 4 to 6 weeks as initial treatment.

2018 ◽  
Vol 32 (1) ◽  
pp. 29-35 ◽  
Author(s):  
Shahine Goulam-Houssein ◽  
Jeffrey L Grenville ◽  
Katerina Mastrocostas ◽  
David G Munoz ◽  
Amy Lin ◽  
...  

IgG4-related disease (IgG4-RD) is a multi-organ chronic inflammatory process caused by infiltration of IgG4-positive plasma cells in one or more organs. Intracranial involvement has only recently become better recognized. Our case series adds to the growing literature on the varying presentations of intracranial IgG4 by describing the clinical and imaging findings of three patients who presented to our institution with intracranial involvement. Our first patient presented with a mass-forming IgG4 pachymeningitis mimicking a sphenoid wing meningioma, which is to our knowledge the largest mass-forming pachymeningitis published in the literature. Our second case depicts another presentation of extensive IgG4 pachymeningitis involving both cavernous sinuses and surrounding Meckel’s caves. The third case describes a patient with presumed lymphocytic hypophysitis, which was later determined to be IgG4-related hypophysitis with concomitant pachymeningitis and perineural spread along the optic nerves. The delayed diagnoses in our cases illustrates the diagnostic challenge that clinicians face in differentiating intracranial IgG4-RD from other infiltrative diseases such as sarcoidosis, granulomatous disease, tuberculosis and lymphoma. Earlier consideration of IgG4-related hypophysitis and hypertrophic pachymeningitis in the differential diagnosis can prevent significant morbidity including unnecessary surgical intervention and organ failure secondary to extensive fibrosis.


Dermatology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Jurr Boer

<b><i>Background:</i></b> Patients with hidradenitis suppurativa (HS) are still often disappointed with the current treatments offered and there is a clear demand for more effective options. Since the late 1990s there has been a revival in the use of radiotherapy (RT) for different benign diseases, including HS. During the past 20 years one case series and some scattered case reports have described promising results of RT. <b><i>Objectives:</i></b> To evaluate the long-term efficacy of RT in early-stage HS. <b><i>Methods:</i></b> A postal survey-based long-term follow-up with simple factual questions of partly retrospective and partly contemporary characteristics was performed. Sixty-four patients (96 axillae), diagnosed with mild to moderate HS were irradiated with a orthovoltage unit with 100 kV, 3 mm Al or 200 kV, 0.5 Cu filtering, respectively. Four to six biweekly fractional doses ranging from 0.75 to 1 Gy up to a total dose of 6 Gy in one series, and in chronic cases followed by four daily fractions of 2 Gy up to a total dose of 14 Gy, were given. Late treatment toxicity and the rate of remission of the disease were evaluated. <b><i>Results:</i></b> The overall response rate of the survey was 64.1% with 40.6% (26/64) valid, complete questionnaires. In total, 40 axillae were irradiated in these 26 patients. After a median follow-up of 40 years (range 32–52) complete remission of the lesions occurred in 34 of the 40 sites (85%). None of the 26 patients with 40 irradiated sites reported adverse effects at the time of the survey. <b><i>Conclusions:</i></b> RT appears to be an effective treatment for early and mild HS in the majority of patients. In this case series, no side effects were reported after a median follow-up period of 40 years.


Author(s):  
Т.А. Богумил

В статье предлагается концепция жизни и творческого роста В.М. Шукшина сквозь призму тезаурусного и кластерного подходов. Объяснительными «персональными моделями» для интерпретации биографического текста писателя являются кластеры Мартина Идена, Гамлета и Степана Разина. Ранее биографы и литературоведы указывали на важность этих персон для Шукшина, но разрозненно. Впервые предпринята попытка свести указанные персональные модели воедино, в целостный сюжет становления писателя в пространстве культуры. На разных этапах эволюции автора доминирует одна из указанных моделей, последовательно сменяя друг друга, но не вытесняя, а «внахлест». Ранний этап творчества, ориентированный на стратегию Мартина Идена, является попыткой «вписаться» в наличный культурный мейнстрим. Выражено это в следовании поэтике соцреализма. Второй этап подспудно начинается с реабилитации отца Шукшина в 1956 года, когда актуализируется «гамлетовский комплекс», проявляющийся в чувстве вины перед отцом, через стратегию утаивания подлинного «я», мотивы чудаковатости. Третий этап связан с личностью реального исторического лица, Степана Разина, и выражается в открытом протесте против власти. Все важные для В.М. Шукшина поведенческие модели объединены мотивом одинокого противостояния враждебному социуму и имеют трагический финал, что обусловило ранний уход писателя и порождение мифов о насильственном характере его смерти. В.М. Шукшин одновременно был фигурой неординарной и типичной, что позволило его биографии стать «персональной моделью» для последующих авторов, выходцев из сельской глубинки. The article proposes the concept of life and creative growth of V.M. Shukshin through the prism of the thesaurus and cluster approach. The explanatory "personal models" for interpreting the biographical text of the writer are clusters of Martin Eden, Hamlet and Stepan Razin. Earlier, biographers and literary critics pointed out the importance of these people for Shukshin, but it was scattered. For the first time, an attempt was made to bring these personal models together into an integral plot of the formation of the writer in the space of culture. At different stages of the writer’s evolution, one of these models dominates, successively replacing each other, but not crowding out, but “overlapping”. The early stage of creativity, focused on Martin Eden’s strategy, is an attempt to “fit in” the current cultural mainstream. This is expressed in following the poetics of socialist realism. The second stage implicitly begins with the rehabilitation of Shukshin’s father in 1956, when the “Hamletian complex” is actualized. It is manifested in a sense of guilt towards his father, the strategy of concealing the true “I”, eccentricities. The third stage is connected with the personality of a real historical person, Stepan Razin, and is expressed in an open protest against the authorities. All important for V.M. Shukshin's behavioral models are united by the motive of a lonely confrontation with a hostile society and have a tragic ending, which led to the early departure of the writer and the generation of myths about the violent nature of his death. V.M. Shukshin was an extraordinary and typical figure at the same time. That allowed his biography to become a “personal model” for subsequent authors who came from the rural outback.


2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Dimitrios Ntourantonis ◽  
Ioannis Seferlis ◽  
Antonis Kouzelis ◽  
...  

The valgus-impacted (VI) 4-part fractures are a subset of fractures of the proximal humerus with a unique anatomic configuration characterized by a relatively lower incidence of avascular necrosis after operative intervention. We systematically reviewed clinical studies assessing the benefits and harms of least possible fixation techniques (LPFT) for this unique fracture type. Such information would be potentially helpful in developing an evidence-based approach in the management of these complex injuries. We performed analytic searches of PubMed, Embase, Web of Science, Google Scholar and the Cochrane Library, restricting it to the years 1991-2014. Included studies had to describe outcomes and complications after primary osteosynthesis with any type of LPFT apart from plate-screws and intramedullary nailing. Eligibility criteria were also included English language, more than 5 cases, minimum follow up of one year and report of clinical outcome using at least one relevant score (Constant, Neer or ASES). Based on 292 database hits we identified 12 eligible studies including 190 four-part valgus impacted fractures in 188 patients. All eligible studies were case series composed of min 8 to max 45 patients per study. The gender distribution was 60% (112) female and 40% (76) male. The average age of the patients at the time of injury was 54.5 years. In 8/12 studies an open reduction was used for fracture fixation using different surgical techniques including KW, cerclage wires, cannulated screws and osteosutures. Closed reduction and percutaneous fixation was used in 4 studies. Mean follow-up time ranged from 24 to 69 months. A good functional outcome (constant score &gt;80) was reported in 9/12 studies. The most common complication was avascular necrosis of the humeral head with an overall incidence of 11% (range, 0-26.3%). Total avascular necrosis (AVN) was found in 15/188 patients (7.9%) and was more common in percutaneous techniques and partial AVN in 6/188 (3.1%) being more common in open techniques. The overall re-operation rate was very low (3.7%). Insufficient study designs cannot provide definite treatment recommendations and quantitative data synthesis of outcome. In general, LPFT for 4-part VI fractures leads to satisfactory outcomes with low incidence of complications. A considerable risk of biases can be attributed to fracture classification, proper radiological control, mean age of patients, mixed types of fixation methods, nonage adjusted clinical scoring and small follow up periods. These factors are discussed in detail. Level of evidence: systematic review of literature (level IV) as most of the studies were level IV.


10.2196/12346 ◽  
2019 ◽  
Vol 3 (4) ◽  
pp. e12346
Author(s):  
Julia Thorpe ◽  
Birgitte Hysse Forchhammer ◽  
Anja M Maier

Background Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. Objective The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. Methods A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. Results Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants’ self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. Conclusions Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come.


2021 ◽  
Vol 6 (2) ◽  
pp. 166-169
Author(s):  
Tudor Mihai Gavrilă ◽  
◽  
Emanuel Antoneac ◽  
Cristea Vlad ◽  
Stefan Cristea

The old unreduced elbow dislocation is not very frequent, but when it is found, it is a challenge for every surgeon. We present a case of 65 years old man who came to the hospital with a dislocated elbow. After the first attempt to reduce, the elbow was mobilized in sling for 2 weeks, but during a small effort, the joint dislocated again. Another two orthopedic reduction were tried, followed by cast immobilization, but the elbow dislocated again. The patient presented in our service after two months from the injury with stiff joint in a vicious position. On imagistic examinations (Rx, CT, MRI), it was found comminuted fracture of coronoid process, posterior dislocation of olecranon and both collateral ligaments were torn. An open reduction was performed during which the joint surface was cleaned up, the anterior capsule was reattached to the coronoid process with an anchor, and then, collateral ligament was restored with the help of autograft, a gracilis muscle (bone fixed with two anchors). Postoperatively, the patient slowly began to mobilize the elbow with splint protection. After a year, the patient returned for follow-up; the function was completely restored and he had no pain.


2020 ◽  
Vol 14 (3) ◽  
pp. 254-259
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sun-Yu Chen ◽  
Zhan-Hao Xiao ◽  
Jian-Kun Wang

Abstract Background The partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function. Methods Twenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery. Results There were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01). Conclusions Arthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.


2018 ◽  
Vol 52 (6) ◽  
Author(s):  
Jimmy A. Billod ◽  
Efren J. Domingo

Majority of cervical cancer are squamous cell carcinoma and adenocarcinoma. The co-existence of two histologic types is rare. This article presents three cases of collision tumors of the cervix within a 10-year review. All underwent radical hysterectomy for an early stage disease. Likewise, it aims to review clinicopathologic features, management, response to treatment and prognosis of these types of tumor in the light of recent literature.


Author(s):  
AKHILA JANGA ◽  
MOHAMMED ZIAUDDIN ◽  
RAVI CHANDER PATLOLLA

Apocrine carcinomas arise from normal or modified sweat glands. The slow-growing nature and rarity of sweat gland carcinomas complicate their diagnosis at the early stage. The incidence of PASGC is quite low at 0.0049–0.0173 cases/100,000 persons/year. A 21-year-old male patient was presented in February 2016 with small solitary mass in the right axilla with mild tenderness and pain. Underwent wide local excision and axillary dissection at our institution followed by adjuvant radio and chemotherapy. Later on, after 18 months developed local recurrence and was planned for re-surgery and a second phase of palliative radiotherapy. After a year, presented to the hospital with pin sized irregular swelling in the axilla. Sweat gland carcinomas which are rarely diagnosed create a pathological dilemma due to their unpredicted biological behavior. However, wide local excision with or without nodal dissection is the primary treatment till date. In this particular case even though patient had underwent axillary node dissection, patient had recurrence twice with no distant metastasis which is a key point to be noted. Thorough study of the available apocrine carcinoma case reports or case series, the better knowledge regarding the apocrine carcinoma can be obtained.


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