CURRENT MANAGEMENT OF JERSEY FINGER IN RUGBY PLAYERS: CASE SERIES AND LITERATURE REVIEW

Hand Surgery ◽  
2010 ◽  
Vol 15 (02) ◽  
pp. 103-107 ◽  
Author(s):  
A. Goodson ◽  
M. Morgan ◽  
G. Rajeswaran ◽  
J. Lee ◽  
E. Katsarma
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Positive Outcome ◽  
Flexor Digitorum Profundus ◽  
Type I ◽  
Tendon Lengthening ◽  
Satisfactory Outcome ◽  
Rugby Players ◽  
Jersey Finger

We discuss a combination of established and modern techniques in the investigation and management of traumatic flexor digitorum profundus rupture ('Rugger Jersey Finger') in seven cases (male rugby players ranging from 15 to 30 years of age; mean = 26). We discuss the use of X-ray and ultrasound investigation followed by various surgical repairs including intraosseous sutures, suture anchors, tendon lengthening and "pull-through suture over button" repairs. Functional outcome at outpatient follow-up is discussed in each case. Type I, II and Vb injuries were identified. Patients presenting early attained good functional outcome. Six patients received surgery within ten days of injury and attained satisfactory outcome at follow-up. One patient presented late and required a tendon lengthening procedure to manage myostatic contracture. Ultrasound imaging proved valuable in diagnosis and pre-operative planning. Numerous surgical repairs were used and all associated with a positive outcome providing there is adequate patient compliance.

A Rare Case of Bilateral Spaghetti Injuries in Children due to Assault by Mother and Analysis of Functional Outcome at Three Years

2021 ◽  
Author(s):  
Parag B. Lad ◽  
N. Venkateshwaran ◽  
M. R. Thatte ◽  
Sanket Tanpure
Keyword(s):  
Functional Outcome ◽  
Case Series ◽  
Sensory Loss ◽  
Nerve Reconstruction ◽  
Range Of Movement ◽  
Flexor Tendons ◽  
Tendon Lengthening ◽  
Flexor Tendon Injuries ◽  
Life Threatening

AbstractManagement of child abuse with flexor tendons, neurovascular injuries, and life-threatening conditions is challenging. It needs a multisectoral coordinated and synchronized team effort for successful outcomes. We present a case series of children abused by a parent with a sharp object. The children sustained multiple flexor tendon injuries, neurovascular injuries in upper limbs, and tracheal injury compromising respiration. We performed a tracheostomy to save a child and subsequently repaired numerous flexor tendons, nerves, and arteries. During follow-up, these children required secondary reconstruction (tenolysis, tendon lengthening, nerve reconstruction) for flexor contractures, stiffness, and sensory loss in distal forearms. We measured the range of movements and assessed the children’s functional outcome using the Strickland score at 3-year follow-up. The range of movement and functional outcome was excellent in both children in our series. A timely performance of surgery, aided with efficient intensive care, therapy, and consistent posttraumatic psychosocial rehabilitation, produced excellent results in our series.

scholarly journals Diastolic dyssynchrony in patients with LV only fusion pacing CRT without RV lead

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Gurgu ◽  
L Petrescu ◽  
C Vacarescu ◽  
CT Luca ◽  
C Mornos ◽  
...  
Keyword(s):  
Lateral Wall ◽  
Positive Outcome ◽  
Type I ◽  
Exercise Tests ◽  
Type Iii ◽  
Funding Sources ◽  
End Diastolic Volume ◽  
Chamber View ◽  
Systolic And Diastolic Function

Abstract Funding Acknowledgements Type of funding sources: None. Background CRT improves both systolic and diastolic function, thus increasing cardiac output. However, less data is available concerning diastolic dyssynchrony and fusion pacing CRT. The aim of our study was to assess the outcome of LV diastolic asynchrony in a population of fusion pacing CRT without right ventricular (RV)  lead. Methods Prospective data were collected from a cohort of patients (pts) with right atrium/left ventricle leads (RA/LV CRT). Baseline and every 6 months follow-up included standard ETT and classical dyssynchrony parameter measurements. Diastolic dyssynchrony was done by offline speckle-tracking derived TDI timing assesment of the simultaneity of E" and A"  basal septal and lateral wall 4 chamber view. New parameters were introduced: E" and respectively A" time (E"T / A"T) as the time difference between E" (respectively A" ) peaks septal and lateral wall. Exercise tests, drugs optimization and device individual programmimg were systematically performed in order to maintain constant fusion and improve CRT response. Patients were divided in three groups: super-responders (SR), responders (R) and non responders (NR). Results Sixty-two pts (35 male) aged 62 ± 11 y.o. with idiopathic DCM implanted with a RA/LV CRT were analyzed: 34%SR / 61%R / 5%NR. Baseline initial characteristics: QRS 164 ± 18 ms; EF 27 ± 5.2; 29% had type III diastolic dysfunction (DD), 63% type II DD, 8% type I DD. Average follow-up was 45 ± 19 months; mean LVEF at the last follow-up was 37 ± 7.9%. The E"T decreased from 90 ± 20 ms to 25 ± 10 ms in SR with significant LV reverse remodelling (LV end-diastolic volume 193.7 ± 81 vs 243.2 ± 82 ml at baseline, p < 0.0028) and lower LV filling pressures (E/E" 13.2 ± 4.6 vs 11.4 ± 4.5, p =0.0295). DD profile improved in 65% of R with a reduction in E/A ratio (1.46 ± 5.3 vs. 0.82 ± 3.9 at baseline, p= 0.4453). Non-sudden cardiac death occurred in 3 NR pts (2%) with type III DD, severe LA volume and larger E" T /A"T (E"T> 85 msec A"T > 30 msec).  Significant cut off value calculated by ROC curve for LV diastolic dyssynchrony is E"T > 80 ms and A"T of > 25 msec. Conclusions Fusion pacing CRT without RV lead showed a positive outcome; improving LV diastolic dyssynchrony in responders and super-responders patients is obvious. Larger randomized studies are needed to define the role of diastolic asynchronism as a predictor of favorable response in fusion pacing. Abstract Figure. Typical TDI patterns in LV fusion pacing

Cartilage Damage Determines Intermediate Outcome in the Late Multiple Ligament and Posterolateral Corner-Reconstructed Knee

2008 ◽  
Vol 36 (2) ◽  
pp. 267-275 ◽  
Author(s):  
Kristoff Corten ◽  
Johan Bellemans
Keyword(s):  
Functional Outcome ◽  
Cartilage Damage ◽  
Case Series ◽  
Posterolateral Corner ◽  
Reliable Technique ◽  
Sling Procedure ◽  
Time Of Surgery ◽  
Functional Scores ◽  
Reconstructed Knee

Background Patients with chronic ruptures of 1 or both cruciate ligaments in combination with posterolateral rotatory instability of the knee often have some degree of cartilage damage at the time of surgery. Hypothesis Chondrosis at the time of reconstruction does not influence early and intermediate functional outcome of the multiple ligament reconstructed knee. Study Design Case series; Level of evidence, 4. Methods Twenty-one patients were available from an original 27 treated between 1995 and 2000. All patients were assessed preoperatively and postoperatively by physical examination and by applying 4 different knee rating scores. All patients were assessed at a mean follow-up of 39 months (range, 14–75 months) and 87 months (range, 62–123 months). Results At the first follow-up, all knee rating scores had improved significantly ( P < .0003) compared with preoperatively; 84% of the reconstructed knees had normal to nearly normal laxities according to the International Knee Documentation Committee 2000 score. At the second follow-up, the functional scores remained significantly ( P < .0089) better than preoperatively. Patients with chondrosis at the time of surgery did not have significantly different knee rating scores at the first follow-up compared with patients without cartilage damage. Four years later, the results in the chondrosis group were significantly worse ( P < .05) for all knee rating scores compared with the patients without chondrosis. The results in 3 of 4 knee rating scores declined significantly in the chondrosis group over the 48-month interval between follow-up sessions. In the Tegner and Lysholm score, the results deteriorated to the preoperative level. Patients with different cruciate ligament reconstructions did not have significantly different knee rating scores. Conclusion The posterolateral sling procedure is a stable and reliable technique for posterolateral corner reconstruction. The presence of chondrosis at the time of surgery is an important prognosticator of functional outcome at intermediate follow-up.

Efficacy, Outcomes, and Alignment Following Isolated Fibular Sesamoidectomy via a Plantar Approach

2019 ◽  
Vol 40 (12) ◽  
pp. 1375-1381 ◽  
Author(s):  
Samuel E. Ford ◽  
Christopher R. Adair ◽  
Bruce E. Cohen ◽  
W. Hodges Davis ◽  
J. Kent Ellington ◽  
...  
Keyword(s):  
Pain Relief ◽  
Functional Outcome ◽  
Case Series ◽  
Office Visit ◽  
Administrative Database ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Tertiary Referral Center ◽  
Flexion Strength

Background: The purpose of this study was to evaluate patients for intermediate-term pain relief, functional outcome, and changes in hallux alignment following isolated, complete fibular sesamoidectomy via a plantar approach for sesamoid-related pain recalcitrant to conservative treatment. Methods: A retrospective query of a tertiary referral center administrative database was performed using the Current Procedural Terminology code 28135 for sesamoidectomy between 2005 and 2016. Patients who underwent an isolated fibular sesamoidectomy were identified and contacted to return for an office visit. The primary outcome measure was change in visual analog pain score at final follow-up. Secondary measures included satisfaction, hallux flexion strength, hallux alignment, pedobarographic assessment, and postoperative functional outcome scores. Patients who met the 2-year clinical or radiographic follow-up minimum were included. Ninety fibular sesamoidectomies were identified. Thirty-six sesamoidectomies met inclusion criteria (median 60-month follow-up). The average patient was 36 years old and underwent sesamoidectomy 1.1 years after initial diagnosis. Results: Median visual analog scale scores improved 5 (6 to 1) points at final follow-up ( P < .001). Final postoperative mean hallux valgus angle did not differ from preoperative values (10.5 degrees/8.5 degrees, P = .12); similarly, the intermetatarsal angle did not differ (8.0 degrees/7.9 degrees, P = .53). Eighty-eight percent of patients would have surgery again and 70% were “very satisfied” with their result. Hallux flexion strength (mean 14.7 pounds) did not differ relative to the contralateral foot (mean 16.1 pounds) ( P = .23). Among the full 92 case cohort, 3 patients underwent 4 known reoperations. Conclusion: Fibular sesamoidectomy effectively provided pain relief (median 5-year follow-up) for patients with sesamoid pathology without affecting hallux alignment. Level of Evidence: Level IV, retrospective case series.

scholarly journals Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

2021 ◽  
Vol 39 (2) ◽  
pp. 114-122
Author(s):  
Abdullah Al Mamun Choudhury ◽  
Md Shah Alam ◽  
Abul Kalam Azad ◽  
Kohinoor Akhter
Keyword(s):  
Functional Outcome ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Injury ◽  
P Value ◽  
Posterior Fixation ◽  
Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

scholarly journals Functional outcome of 103 fractures of the proximal fifth metatarsal bone

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Patrick Pflüger ◽  
Michael Zyskowski ◽  
Michael Müller ◽  
Chlodwig Kirchhoff ◽  
Peter Biberthaler ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Rank Correlation ◽  
Metatarsal Bone ◽  
Outcome Analysis ◽  
Functional Score ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Fifth Metatarsal Bone

Abstract Background Metatarsal fractures are common skeletal injuries of the lower extremity in adults. The majority involves the proximal fifth metatarsal bone. In the current literature, there still exists controversy regarding treatment recommendations for the different fracture entities. Methods All patients suffering from single fractures to the proximal fifth metatarsal bone between 2003 and 2015 were enrolled in this retrospective analysis. Only patients with a minimum follow-up of 12 months were included. The fractures were classified according to Lawrence and Botte (L&B). Data were collected via patient registry, radiographs and a standardized questionnaire (Foot and Ankle Outcome Score = FOAS). For outcome analysis, the nonparametric Mann–Whitney U test was performed and Spearman’s rank correlation coefficient calculated. Results In total, the functional outcomes of 103 patients suffering from fractures to the proximal fifth metatarsal bone were analyzed. L&B type I fractures (n = 13) had a FAOS score of 91 ± 23, L&B type II (n = 67) presented a score of 91 ± 15 and L&B type III (n = 23) a score of 93 ± 11. Surgically treated patients with an L&B type II fracture had no statistically significant better functional outcome in comparison to conservative management (p = 0.89). Operatively treated L&B type III fractures tended to have a better functional score (p = 0.16). The follow-up time was 58 (min: 15; max: 164) months. Conclusions Overall, the functional outcome following fractures to the proximal fifth metatarsal bone is satisfactory. Conservatively treated L&B type II fractures showed an equivalent functional outcome compared to surgical management. Patients with an L&B type III fracture mainly were treated surgically, but difference in FAOS score did not reach level of significance.

scholarly journals Clinical and Radiological Outcomes of Subtalar Kalix II Arthroereisis for a Symptomatic Pediatric Flexible Flatfoot

2019 ◽  
pp. 193864001989206 ◽  
Author(s):  
Robin T. A. L. de Bot ◽  
Jasper Stevens ◽  
Joris P. S. Hermus ◽  
Heleen M. Staal ◽  
Lodewijk W. van Rhijn ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Functional Outcome ◽  
Revision Surgery ◽  
Clinical Symptoms ◽  
Case Series ◽  
Postoperative Phase ◽  
Levels Of Evidence ◽  
Flexible Flatfoot ◽  
Subtalar Arthroereisis

Background. The purpose of this study is to evaluate functional and radiological outcomes of subtalar arthroereisis in the treatment of symptomatic pediatric flexible flatfeet. Methods. A total of 16 patients (26 feet) were treated with a Kalix II as subtalar motion blocker between 2009 and 2014. Calcaneal pitch (CP) and Meary’s angle (MA) were measured on radiographs preoperatively, directly postoperatively, and at follow-up 47 ± 17 (range 19-79) months. Patient satisfaction surveys were used to assess functional outcome and patient satisfaction. Results. Surgery was performed mostly for pain, walking problems, or a combination of both at a mean age of 12.5 ± 1.5 (range 10-15) years. Symptoms were relieved in 62.5% of patients in the postoperative phase and increased to 68.75% at follow-up. A statistically significant increase in CP of 2.8° and decrease in MA of 14.0° was observed directly postoperatively, which persisted during the follow-up period irrespective of Kalix removal. Revision surgery was necessary in 6 cases (23%) because of arthroereisis migration. Conclusion. Subtalar Kalix II arthroereisis significantly reduced clinical symptoms and improved the CP and MA directly postoperatively, which persisted during follow-up, irrespective of Kalix removal. Therefore, subtalar arthroereisis is a considerable intervention to reduce symptoms in children with symptomatic flexible flatfeet. Levels of Evidence: Level IV: Case series

scholarly journals Investigating clinical characteristics and prognostic factors in patients with chronic osteomyelitis of humerus

2019 ◽  
Vol 7 ◽  
Author(s):  
Hongri Wu ◽  
Shengpeng Yu ◽  
Jingshu Fu ◽  
Dong Sun ◽  
Shulin Wang ◽  
...  
Keyword(s):  
Chronic Osteomyelitis ◽  
Plate Fixation ◽  
Case Series ◽  
Type I ◽  
Cement Spacer ◽  
Nerve Injuries ◽  
Soft Tissue Envelope ◽  
Type Iv ◽  
Significant Difference

Abstract Background Chronic osteomyelitis in the humerus, which has complex neuroanatomy and a good soft tissue envelope, represents a unique clinical challenge. However, there are relatively few related studies in the literature. This article retrospectively reviewed a large case series with the aims of sharing our management experiences and further determining factors associated with the outcomes. Methods Twenty-eight consecutive adult patients with a mean age of 36 years were identified by reviewing the osteomyelitis database of our clinic centre. The database was used to prospectively identify all osteomyelitis cases between 2013 and 2017, and all data then was retrospectively analysed. Results The mean follow-up period was 35 months (range 24–60). The aetiology was trauma in 43% (12) of the patients and haematogenous in 57% (16) of the patients, and Staphylococcus aureus was a solitary agent in 50% (14) of the patients. Host-type (Cierny’s classification) was IA in 8, IIIB in 11 and IVB in 9 patients. All patients required debridement followed by the placement of a temporary antibiotic-impregnated cement spacer (rod). Seventeen patients received a cement-coated plate for internal fixation after debridement, and 13 patients needed bone grafts when the spacer was staged removed. All patients attained an infection-free bone healing state at the final follow-up. The final average DASH (disabilities of the arm, shoulder and hand) score was 18.14 ± 5.39, while 6 patients (two developed traumatic olecranarthritis, four developed radial nerve injuries) showed the lowest levels of limb function (p = 0.000) and were unemployed. Three patients (type I; significant difference between type I versus type III and type IV patients, p &lt; 0.05) experienced recurrence after debridement and underwent a second revision, which was not related to the bone graft (p = 0.226) or plate fixation (p = 0.050). Conclusions Humeral chronic osteomyelitis can be treated with general surgery and anti-infective therapy; medullary (type I) infection presents a challenge, and the antibiotic-coated cement plate provides favourable fixation without increasing recurrence of infections. Clinicians should be aware of potential iatrogenic nerve injuries when treating these patients with complicated cases, and an experienced surgeon may improve the outcome.

scholarly journals Surgical and Protocolized Management of Distal Radius Nonunion

2020 ◽  
Vol 48 (02) ◽  
pp. 79-86
Author(s):  
Juan María Pardo García ◽  
Verónica Jiménez Díaz ◽  
Amaya Barberia Biurrun ◽  
Lorena García Lamas ◽  
Miguel Porras Moreno ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Distal Radius ◽  
Case Series ◽  
Degenerative Changes ◽  
Average Score ◽  
Type I ◽  
Bone Stock ◽  
Type Iii ◽  
Metaphyseal Bone

Abstract Introduction Nonunion of the distal radius is an extremely rare and serious complication with unpredictable outcomes. The aim of the present study is to analyze the radiological and functional results after a protocolized surgical treatment. Material and Methods A retrospective review of case series of patients with diagnosis of nonunion of the distal radius surgically treated from 2010 to 2016. The diagnosis of nonunion was made at 6 months without signs of consolidation. According to computed tomography (CT) scan images, we propose a classification of this complication as type I: no deformity or mild deformity, with subchondral metaphyseal bone stock beneath lunate facet greater than 10 mm, with no degenerative changes at the distal radioulnar joint (DRUJ); type II: moderate deformity or degenerative changes in the DRUJ, distinguishing between IIA and IIB based on the subchondral metaphyseal bone stock; and type III: degenerative changes at the midcarpal joint. In all cases, a reconstructive technique consisting of volar locking plate osteosynthesis with autologous tailored iliac crest graft was performed, hence none of the cases were classified as type III. Results In total, six cases were included. Mean follow-up: 58 months (range: 30–108 months). Consolidation was achieved in a mean period of 5 months (range: 3–9 months). Average active range of motion: flexion: 54° (range: 10°–80°); extension: 40° (range: 10°–85°); supination: 82.5° (range: 75°–85°); pronation 80° (range: 55–85°); radial deviation: 15° (range: 5°–20°); and ulnar deviation 15° (range: 5–20°). Mean strength: 24.15 Kg (6.9–35 Kg). The average score on the Visual Analog Scale (VAS) at rest was of 0.6 (0–2), and with movement, it was of 1.8 (0–4). The mean postoperative score on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was of 18.48 (range: 0–50.8). Average radial height: 9.65 mm (range: 7–12 mm); average radial angulation: 17° (10°–20°); volar tilt: 8.36° (range: 0.2°–21°); average ulnar variance: 1.52 mm (range: 0–3.5 mm). Complications: persistent nonunion, superficial wound infection, acquired residual ulnar club hand deformity, radiocarpal arthritis, and midcarpal arthritis. Nevertheless, no salvage techniques were needed or requested during the follow-up, with all patients in an active work situation or living an active life in complete normality. Conclusions The protocolized surgical treatment of pseudoarthrosis of the the distal radius, based on our proposed classification, offers good functional outcomes in the long-term follow-up.

Hook Plate as a Treatment for Flexor Digitorum Profundus Avulsion Types II and III

Hand ◽  
2020 ◽  
pp. 155894472095773
Author(s):  
Manel Fa-Binefa ◽  
Gonzalo Pérez-López ◽  
Marta Almenara ◽  
Claudia Lamas
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Flexor Digitorum Profundus ◽  
Wide Range ◽  
Scale Range ◽  
Surgical Fixation ◽  
Fracture Types ◽  
Flexor Digitorum ◽  
Jersey Finger

Avulsion fracture types II and III of flexor digitorum profundus (FPD), also called Jersey Finger, in flexor zone 1 are an uncommon pathology requiring surgical treatment. The aim of this study was to assess whether hook miniplates were an accessible and reliable option to repair FDP avulsion types II and III. Between July and August 2018, we treated 2 consecutive patients’ zone 1 Leddy-Packer type II and III FDP injuries with hook plates and 1.2 × 7 mm screws included in Medartis Aptus Hand fixation system set. Patients were aged 37 and 39 years, a man and a woman, respectively. At the end of the follow-up, we evaluated the Visual Analog Scale, range of motion, grip strength, and Quick Disabilities of the Arm, Shoulder, and Hand. Both patients completed 12 months of follow-up with excellent functional and radiological results. Neither presented complications or residual disability. This injury has been treated with a wide range of surgical techniques, including anchor suture, pullout button sutures, screws, and plates. However, due to the difficulty in surgical fixation of fragments around finger joints, limited access to ligaments and tendons, and the lack of cases, none of the techniques have turned out as a clear option above others. Hook plates placed in distal phalanx emerge as surgical treatment for FDP avulsion types II and III in flexor zone 1, with excellent clinical outcomes.

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