Novel Use of an Internal Distractor for Metacarpal Lengthening

Hand ◽  
2021 ◽  
pp. 155894472110527
Author(s):  
Laura E. Bashour ◽  
Charles Hill ◽  
Sarah A. Frommer ◽  
Steven L. Henry
Keyword(s):  
Kirschner Wire ◽  
Case Series ◽  
Senior Author ◽  
Distraction Device ◽  
Low Profile ◽  
Device Placement ◽  
Final Length ◽  
And Function ◽  
Age Range ◽  
Length Gain

Background In patients who have had proximal digit amputation, metacarpal distraction osteogenesis is an option to improve digital length and function. One drawback is that traditional external distraction devices are large and cumbersome; the option of a low-profile internal device is therefore appealing. Internal distractors are commonly used in craniofacial reconstruction, but use in the hand has not been reported. We describe a case series of the novel use of an internal distractor in metacarpal lengthening. Methods In this single-center case series, patients who underwent metacarpal distraction by the senior author using a uniplanar internal distractor were reviewed, and indications, outcomes, and complications were analyzed. Results There were 5 cases in 4 patients (age range: 7-33 years). Indications were traumatic amputation in 4 cases and congenital hypoplasia in 1. All were successfully distracted, with a mean final length gain of 1.3 cm (range: 1.0-1.7 mm). Mean time from device placement to consolidation was 3.5 months. Complications included activation arm site infection in 2 cases, both occurring after the distraction period, necessitating device removal before full consolidation. In these cases, the device was removed after the distraction period and replaced with a Kirschner wire for stabilization through the consolidation period. Conclusions Metacarpal distraction was successfully achieved with an internal distraction device. Although infection was common, it occurred after the distraction period and did not preclude length gain. We feel that this low-profile device offers advantages over cumbersome external devices typically used for metacarpal lengthening.

scholarly journals Reconstructing the Face of War

2019 ◽  
Vol 184 (7-8) ◽  
pp. e236-e246 ◽  
Author(s):  
Scott J Farber ◽  
Kerry P Latham ◽  
Rami S Kantar ◽  
Jonathan N Perkins ◽  
Eduardo D Rodriguez
Keyword(s):  
Medical Center ◽  
Case Series ◽  
High Energy ◽  
Senior Author ◽  
Clinical Images ◽  
War Injuries ◽  
Form And Function ◽  
Institutional Review ◽  
Institutional Review Board Review ◽  
And Function

Abstract Introduction Ongoing combat operations in Iraq, Afghanistan, and other theaters have led to an increase in high energy craniomaxillofacial (CMF) wounds. These challenging injuries are typically associated with complex tissue deficiencies, evolving areas of necrosis, and bony comminution with bone and ballistic fragment sequestrum. Restoring form and function in these combat-sustained CMF injuries is challenging, and frequently requires local and distant tissue transfers. War injuries are different than the isolated trauma seen in the civilian sector. Donor sites are limited on patients with blast injuries and they may have preferences or functional reasons for the decisions to choose flaps from the available donor sites. Methods A case series of patients who sustained severe combat-related CMF injury and were treated at Walter Reed National Military Medical Center (WRNMMC) is presented. Our study was exempt from Institutional Review Board review, and appropriate written consent was obtained from all patients included in the study for the use of representative clinical images. Results Four patients treated by the CMF team at Walter Reed National Military Medical Center are presented. In this study, we highlight their surgical management by the CMF team at WRNMMC, detail their postoperative course, and illustrate the outcomes achieved using representative patient clinical images. We also supplement this case series demonstrating military approaches to complex CMF injuries with CMF reconstructive algorithms utilized by the senior author (EDR) in the management of civilian complex avulsive injuries of the upper, mid, and lower face are thoroughly reviewed. Conclusion While the epidemiology and characteristics of military CMF injuries have been well described, their management remains poorly defined and creates an opportunity for reconstructive principles proven in the civilian sector to be applied in the care of severely wounded service members. The War on Terror marks the first time that microsurgery has been used extensively to reconstruct combat sustained wounds of the CMF region. Our manuscript reviews various options to reconstruct these devastating CMF injuries and emphasizes the need for steady communication between the civilian and military surgical communities to establish the best care for these complex patients.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Primary Calvarial Ewing Sarcoma: A Case Series

2021 ◽  
Author(s):  
Sandeep Mohindra ◽  
Manjul Tripathi ◽  
Aman Batish ◽  
Ankur Kapoor ◽  
Ninad Ramesh Patil ◽  
...  
Keyword(s):  
Ewing Sarcoma ◽  
Tumor Resection ◽  
Case Series ◽  
Radical Excision ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Intradural Tumor ◽  
Age Range

Abstract Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Same-Admission Microvascular Maxillofacial Ballistic Trauma Reconstruction Using Virtual Surgical Planning: A Case Series and Systematic Review

2021 ◽  
pp. 194338752110264
Author(s):  
Sean A. Knudson ◽  
Kristopher M. Day ◽  
Patrick Kelley ◽  
Pablo Padilla ◽  
Ian X. Collier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Surgical Planning ◽  
Average Length ◽  
Case Series ◽  
Retrospective Case ◽  
Oral Nutrition ◽  
Microsurgical Reconstruction ◽  
Virtual Surgical Planning ◽  
And Function ◽  
Ballistic Trauma

Study Design: Retrospective case series; systematic review. Objective: It is unknown whether the use of virtual surgical planning (VSP) to facilitate same-admission microsurgical reconstruction of the mandible following acute maxillofacial ballistic trauma (MBT) is sufficient to achieve definitive reconstruction and functional occlusion. Methods: A single-center retrospective analysis was conducted for patients who underwent microsurgical reconstruction of the mandible using VSP after acute MBT. The PubMed/MEDLINE, Embase, ScienceDirect, and Scopus databases were systematically reviewed using blinded screening. Studies were evaluated via thematic analysis. Results: Five patients were treated by same-admission and microsurgical reconstruction of the mandible using VSP. We observed an average of 16.4 ± 9.1 days between initial presentation and reconstruction, an average length of stay of 51.6 ± 17.9 days, 6.2 ± 2.8 operations, and 1.6 ± 0.9 free flaps per patient. Four types and 8 total flaps were employed, most commonly the anterior lateral thigh flap (37.5%). Care yielded complete flap survival. Each patient experienced at least 1 minor complication. All patients achieved centric occlusion, oral nutrition, and an approximation of their baseline facial aesthetic. Follow up was 191.0 ± 183.9 weeks. Systematic review produced 8 articles that adhered to inclusion criteria. Consensus themes in the literature were found for clinical goal and function of VSP when practicing MBT reconstruction, yet disagreement was found surrounding optimal treatment timeline. Conclusions: Same-admission microsurgical reconstruction after MBT is safe and effective to re-establish mandibular form and function. VSP did not delay reconstruction, given the need for preparation prior to definitive reconstruction.

Description and Clinical Assessment of the Bone Block Tendon Interposition Technique for the Management of Thumb Carpometacarpal Joint Osteoarthritis

2018 ◽  
Vol 23 (04) ◽  
pp. 515-519
Author(s):  
Diego F. Rincon Cardozo ◽  
Wynston J. Alvarez Martinez ◽  
Jhon F. Castañeda Lopez ◽  
Fredy A. Angarita Maldonado ◽  
Juliana A. Rojas Neira ◽  
...  
Keyword(s):  
Case Series ◽  
Functional Results ◽  
Interference Screw ◽  
Pinch Strength ◽  
Bone Block ◽  
Dash Score ◽  
Carpometacarpal Joint ◽  
Thumb Carpometacarpal Joint ◽  
Thumb Carpometacarpal ◽  
And Function

Background: Pellegrini’s surgical technique is the most useful for thumb carpometacarpal joint osteoarthritis. The purpose of this paper is to describe the technique of a modified version using a bone block in the tunnel through which the flexor carpi radialis tendon is passed (BBTI). Methods: Case series of patients diagnosed with osteoarthritis of the thumb carpometacarpal joint, in stage II or higher based on Eaton’s classification, that were intervened using the BBTI technique for a 2-year period. Grip and pinch strength, range of motion, and 1–2 metacarpal angle were evaluated. Pain and function were measured using the visual analogue scale and the Disabilities of the Arm, Shoulder and Hand (DASH) scale. Results: The study included 16 cases in 14 patients (11 women and 3 men), with an average age of 55.7 ± 7.1 years. Encouraging results were obtained, with an average DASH score of 24.3 ± 17.9 and a minimum VAS pain score. A total of 58% showed a grip strength of over 80% and the postoperative movement was equivalent to the contralateral limb. No cases of infection were reported, and only two minor complications were observed. Conclusions: The BBTI technique is a surgical option that incorporates an interference screw, offering good functional results for managing osteoarthritis of the thumb carpometacarpal joint, with a similar complication rate to that of the original technique.

scholarly journals Relationship of Depression and function of Attention, Planning and Verbal Learning and Memory

2019 ◽  
Vol 8 (9) ◽  
pp. 214-225
Author(s):  
Nongmeikapam Premika Devi
Keyword(s):  
Learning And Memory ◽  
Verbal Learning ◽  
Education Level ◽  
Auditory Verbal Learning ◽  
And Function ◽  
Age Range ◽  
Relationship Of ◽  
The Relationship ◽  
Minimum Education ◽  
Hiv Aids

The present study examines the relationship of depression and the neuropsychologicalfunction of attention, planning and auditory verbal learning and memory among individualswith HIV/AIDS. 200 subjects who were HIV/AIDS positive (100 males and 100 females) andwere within age range of 20 to 50 years and minimum education level of 8th standard weretaken. The result indicates that Depression slows down the performance of attention; alsodepression most likely decreases the function of auditory verbal learning and memory

scholarly journals EFFECT OF SUBCUTANEOUS RECOMBINANT HUMAN ERYTHROPOIETIN ON BLOOD PRESSURE IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE (CKD) PATIENTS

2021 ◽  
Vol 71 (1) ◽  
pp. 261-65
Author(s):  
Muhammad Sajid Hussain ◽  
Qasim Raza ◽  
Muhammad Omer Aamir ◽  
Nadia Murtaza ◽  
Sadia Naureen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Body Weight ◽  
Kidney Disease ◽  
Recombinant Human Erythropoietin ◽  
Case Series ◽  
Military Hospital ◽  
P Value ◽  
Human Erythropoietin ◽  
Age Range

Objective: To determine the effect of subcutaneous recombinant human erythropoietin on blood pressure in predialysis chronic kidney disease (CKD) patients. Study Design: Case-series descriptive study. Place and Duration of Study: Combined Military Hospital Peshawar, from Mar 2016 to Sep 2016. Methodology: A total of 100 cases were enrolled. Inclusion criteria was patients of 18 to 60 years of both gender & estimated glomerular filtration rate (eGFR) below 30 mL/min/1.73 m2 having Hb <10g/dL and pre-dialysis while Exclusion Criteria was pregnancy or lactation, BP more than 140/90 mmHg, patients on Haemodialysis and worsening renal function. Baseline BP, body weight and eGFR of anaemic chronic kidney disease patients were recorded prior to EPO Alpha therapy. Erythropoiesis-stimulating agents (ESAs) i.e. EPO Alpha (50-100 Units/kg thrice or once weekly) was administered subcutaneously. Subsequent blood pressure, body weight and eGFR monitoring was done after 2 and 4 weeks post EPO Alpha injection. Results: Mean age range was 46.71 years with range of 20-60 years, 73 (73%) were male while 27 (27%) werefemales. Mean ± SD for other quantitative variables like eGFR was 23.12 ± 5.28, Hb levels (g/dL) was 8.62 ± 0.85,Weight (kg) was 56.66 ± 6.62 and duration of CKD was 9.87 ± 4.02. Frequency of Hypertension (post EPO) was 2(2%) and p-value was 0.453. Conclusion: We concluded that the frequency of hypertension in pre-dialysis patients with chronic kidney disease (CKD) receiving recombinant human erythropoietin (rhEPo) subcutaneously (SC) in low doses, is very low, so rhEPo can be used subcutaneously......................

scholarly journals Reliability and Safety of Contra-Lateral Oblique View for Interlaminar Epidural Needle Placement

2018 ◽  
Vol 1 (21;1) ◽  
pp. E65-E73
Author(s):  
Richard Derby
Keyword(s):  
Epidural Space ◽  
Ligamentum Flavum ◽  
Case Series ◽  
Senior Author ◽  
Epidural Block ◽  
Observer Agreement ◽  
Epidural Needle ◽  
Oblique View ◽  
Fluoroscopic Imaging

Cord trauma is a risk with a cervical and thoracic interlaminar epidural approach to the epidural space. Intermittent lateral fluoroscopic imaging to detect needle depth is often cumbersome and may be difficult to interpret. In comparison, the contra-lateral oblique (CLO) fluoroscopic view is efficient and easy to interpret. However, the in vivo reliability and safety of this technique has not been formally investigated. The senior author collected fluoroscopic images on 278 consecutive patients undergoing an interlaminar epidural block at the T1-T2 level performed using a 17 gauge Tuohy needle. Before catheter placement, anterior-posterior (AP) and CLO fluoroscopic images were saved with the needle at the ligamentum flavum and the needle just through the ligamentum flavum. We randomly selected the images of 40 cases that included the paired CLO images (total 80 images) documenting the views at and through the ligamentum flavum. Three interventionalists were asked to review, in a blinded fashion, the randomly selected, paired CLO images and to score each image, recording whether the 17 gauge needle was in or out of the epidural space to determine the accuracy and reliability of this technique. There was a 97.5%, 95%, and 93.8% agreement between each reviewing physician and the senior author resulting in a correlation using the Kappa statistic value of 0.950, 0.875, and 0.874, respectively (P < 0.001). The 3 reviewing physicians disagreed with the senior author’s correct answer in 2.5%, 5%, and 6.2%, respectively, however, the disagreement occurred primarily because of poor image quality. Agreement between the 3 reviewing physicians was 93.8%, 96.3%, and 90%, with a Kappa value of 0.875, 0.924, and 0.799, respectively (P < 0.001). There was 100% technical success in the 278 case series without “wet taps,” provocation of pain during entry, or any other immediate post procedural complication. We conclude the CLO view provides an efficient and reliable method to visualize needle tip depth in relation to the epidural space. The close inter-observer agreement was possible with minimal physician instruction. Key words: Cervical interlaminar, cervical epidural, contra-lateral oblique, fluoroscopic imaging

Acute Isoniazid Neurotoxicity in an Urban Hospital

PEDIATRICS ◽  
1995 ◽  
Vol 95 (5) ◽  
pp. 700-704
Author(s):  
Binita R. Shah ◽  
Karen Santucci ◽  
Richard Sinert ◽  
Phillip Steiner
Keyword(s):  
New York ◽  
Case Series ◽  
Pediatric Emergency ◽  
Tuberculous Infection ◽  
Urban Hospital ◽  
Average Delay ◽  
Number Of Children ◽  
Refractory Seizures ◽  
Age Range ◽  
Increasing Trends

Objectives. To describe the presentation and treatment of acute isoniazid (INH) neurotoxicity appearing at an inner-city municipal hospital. Design. Case series. Participants. Seven patients (eight patient visits) with an age range of 5 days to 14.9 years. Results. At our institution, no children appeared with acute INH neurotoxicity in the period 1985 through 1990, whereas seven patients were treated from 1991 through 1993. This paralleled the rise in the number of children with tuberculous infection and disease seen at our institution, from an average 96 per year to 213 per year during these two time periods. All seven patients were receiving INH daily for tuberculosis (TB) prophylaxis. Accidental ingestion (five episodes) and suicidal attempts (three episodes) accounted for these visits. The total amount ingested range from 14.3 to 99.3 mg/kg (mean, 54 mg/kg). All but one patient presented with afebrile seizures. One patient presented twice with seizures. Acute INH neurotoxicity was not suspected on the first admission; however, when readmitted 4 weeks later with another seizure, the diagnosis of acute INH neurotoxicity was made. Intervention. Intravenous pyridoxine was used in five episodes. Because it was not a stocked item in our pediatric emergency cart (as well as at another hospital, necessitating a transfer of a patient with refractory seizures to our hospital), the average delay was 5.8 hours (range, 1.3 to 13 hours) before it was given. Two patients with refractory seizures failed to respond to anticonvulsants, and their seizures were controlled only after parenteral pyridoxine. Conclusions. We have seen an increased incidence of acute INH neurotoxicity because of the resurgence of TB in New York City. Others as well may see a similar rise based on local trends in TB infection and disease. Acute INH toxicity should be suspected in children presenting with seizures with or without fever. In patients with a known access to INH, seizures should be considered to be caused by INH toxicity unless proved otherwise. Parenteral pyridoxine, the specific antidote for INH-induced refractory seizures, should be readily available in every emergency department in the areas similarly experiencing increasing trends of TB.

Radial Artery Access for Treatment of Posterior Circulation Aneurysms Using the Pipeline Embolization Device: Case Series

2019 ◽  
Vol 17 (4) ◽  
pp. 340-347 ◽  
Author(s):  
Eytan Raz ◽  
Maksim Shapiro ◽  
Razvan Buciuc ◽  
Peter Kim Nelson ◽  
Erez Nossek
Keyword(s):  
Case Series ◽  
Vascular Anatomy ◽  
Artery Aneurysm ◽  
Posterior Circulation ◽  
Femoral Access ◽  
Pipeline Embolization Device ◽  
Aneurysm Treatment ◽  
Posterior Circulation Aneurysm ◽  
Device Placement ◽  
Posterior Circulation Aneurysms

AbstractBACKGROUNDThe treatment of selected wide-neck and fusiform posterior circulation aneurysms is challenging for clipping as well as for endovascular route.OBJECTIVETo describe an endovascular approach for vertebral artery aneurysm treatment using transradial access (TRA) instead of the conventional transfemoral access.METHODSWe collected cases from two institutions in which TRA was used for posterior circulation Pipeline Embolization Device (Medtronic, Dublin, Ireland) deployment.RESULTSA total of four patients were treated. TRA was useful in the setting of extreme vessel tortuosity. We utilized 5F Terumo Glidesheath (Terumo Medical, Somerset, New Jersey), intermediate catheter, and a 027 microcatheter for Pipeline deployment. TRA was not associated with any access or deployment difficulties.CONCLUSIONSEarly experience suggests that TRA for Pipeline Embolization Device placement for posterior circulation aneurysm is a safe and efficient alternative to standard transfemoral access. While this approach was initially applied to patients with vascular anatomy that may not allow for safe femoral access or navigation, experience so far argues for considering a radial approach towards some posterior circulation aneurysm treatment.

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