scholarly journals Understanding the spectrum of paediatric mechanical finger and hand trauma seeking acute care

2018 ◽  
Vol 12 (6) ◽  
pp. 622-628
Author(s):  
R. F. Gibly ◽  
T. Shomaker ◽  
V. Bompadre ◽  
S. E. Steinman
Keyword(s):  
Proximal Phalanx ◽  
Case Series ◽  
International Classification Of Diseases ◽  
Tertiary Hospital ◽  
Hand Injuries ◽  
Urgent Care ◽  
Hand Trauma ◽  
Level Of Evidence ◽  
Medical Evaluation ◽  
Bony Segment

Purpose Paediatric hand injuries are a frequent reason for acute medical evaluation. Previous studies have reported only fracture rates, surgical injuries or are limited to database diagnosis coding. The average fracture rates and injury distributions across the hand for all mechanical injuries have not been well-described. Methods We performed a retrospective review of all emergent/urgent care visits over 18 months at a US paediatric tertiary hospital with hand injuries recorded anywhere in the encounter. Patient, injury and encounter details were recorded with additional imaging review, categorized and described. Results A total of 523 patient visits (0.64% of all encounters) were for mechanical hand trauma. The injury mechanism was 42% crush, 19% jammed, 12% impact, 12% fall on outstretched hand, 7% hyperextension and 8% other/unclear. Crush was responsible for 80% of injuries in patients aged 0 to six years old but only 17% in patients aged 13 to 18 years. Crush resulted in fractures only 26% of the time, while other mechanisms were more likely to fracture (33% to 87%). Border digits were injured more often than others (21% to 23% versus 13% to 17%), and were most commonly fractured in the proximal phalanx (57% to 67% versus 22% to 34% for non-border digits). Providers correctly coded for basic fracture presence in 89.1% of injuries, but 53% of codes were not finger or laterality-specific, and only 15% specified a bony segment demonstrating that International Classification of Diseases-9 coding was nonspecific for injury patterns. Conclusion Patients with paediatric hand injuries frequently utilize emergency care and understanding the basic patterns of injury can guide resource utilization and future studies on optimal treatment algorithms in this setting. Level of Evidence IV, Prognostic, Case Series

Radiographic Correlation of Hallux MP Fusion Position and Plate Angle

2009 ◽  
Vol 30 (9) ◽  
pp. 873-876 ◽  
Author(s):  
J. Thaddeus Leaseburg ◽  
James K. DeOrio ◽  
Shane A. Shapiro
Keyword(s):  
Weight Bearing ◽  
Proximal Phalanx ◽  
Case Series ◽  
Statistical Correlation ◽  
Titanium Plate ◽  
Care Needs ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Lower Correlation ◽  
Proper Weight

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series

The Epidemiology of Operative Pediatric Hand Trauma: A Retrospective Chart Review

Hand ◽  
2019 ◽  
pp. 155894471989303
Author(s):  
John C. Koshy ◽  
Luke J. Grome ◽  
Kelly Schultz ◽  
Bryce Bell ◽  
Edward Reece ◽  
...  
Keyword(s):  
Chart Review ◽  
Wide Spectrum ◽  
Pediatric Population ◽  
Proximal Phalanx ◽  
Retrospective Chart Review ◽  
Hand Injuries ◽  
Hand Trauma ◽  
Average Patient ◽  
Motorized Vehicles ◽  
Complex Injuries

Background: Hand injuries are common in the pediatric population with a wide spectrum of morbidity that can occur. Simple injuries are distinguished from complex injuries by the number of fingers/systems that are involved. The epidemiology of simple and complex operative hand trauma in the pediatric population has not yet been defined. Methods: A retrospective review was performed of all pediatric patients requiring operative intervention for hand trauma at a major children’s hospital over a 3-year period (2015-2017). Data pertaining to demographics, mechanism, severity, type of surgery, and other factors related to hand trauma were then analyzed and interpreted. Results: Three hundred seventy-one pediatric hand injuries over a 3-year period required surgical intervention, with 19.2% being classified as complex. The average patient age was 11.0 years. A total of 68.7% of patients were men. Bony injuries made up 86.3% of simple injuries, with the proximal phalanx being the most commonly fractured bone. Complex injuries occurred more frequently in men and required a greater number of surgeries (1.6 vs 1.0). Of the complex injuries, only major injuries (severity score >100) required a significantly greater number of surgeries. Major hand injuries were mostly caused by motorized vehicles and required a significantly greater number of surgeries (3.8), compared with other causes of injuries. Conclusions: Operative hand injuries occur along a spectrum of morbidity in the pediatric population. While most of the injuries are simple and require only 1 procedure, more complex injuries can also occur and deserve a higher level of care and attention.

scholarly journals Tibiocalcaneal arthrodesis in fixed equinus deformity with ring fixator

2019 ◽  
Vol 13 (2) ◽  
pp. 166-171
Author(s):  
Rafael Bispo de Souza ◽  
Antônio Carlos Faloni Nunes Pereira ◽  
Rafael Costa Nerys ◽  
Jefferson Soares Martins ◽  
Edegmar Nunes Costa
Keyword(s):  
Quality Of Life ◽  
Case Series ◽  
Tertiary Hospital ◽  
Limb Function ◽  
Level Of Evidence ◽  
Ring Fixator ◽  
Tibiocalcaneal Arthrodesis ◽  
Sf 36 ◽  
Equinus Deformity

Objective: To evaluate the limb function and quality of life of patients with posttraumatic fixed equinus deformity treated at a tertiary hospital after arthrodesis with the Ilizarov external fixator. Methods: A study was conducted from January 2015 to June 2018 in which 6 patients were evaluated at outpatient follow-up in the late postoperative period. First, an identification questionnaire was administered to assess limb function using the American Orthopedic Foot and Ankle Society (AOFAS) scale, and quality of life was assessed using the SF-36 questionnaire. Results: A total of 66.6% of the sample had an AOFAS score below 70 (mean total = 57.5), which is considered poor. The mean SF-36 score was low (below 60) in all domains evaluated. The pain domain had the highest score (mean = 57.2). Conclusions: Even after surgery to correct the deformity, patients had impaired function and quality of life. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals EVALUATION OF DISTAL FOREARM FRACTURES USING THE AO 2018 CLASSIFICATION

2019 ◽  
Vol 27 (4) ◽  
pp. 220-222
Author(s):  
Alysson Figueiredo Nogueira ◽  
Lucas Moratelli ◽  
Marcela dos Santos Martins ◽  
Ricardo Torres Iupi ◽  
Marcos Felipe Marcatto de Abreu ◽  
...  
Keyword(s):  
Case Series ◽  
Tertiary Hospital ◽  
Common Type ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Level Of Evidence ◽  
Ulnar Fracture ◽  
Limb Fractures ◽  
Distal Forearm Fractures ◽  
Age And Sex

ABSTRACT Objective: Distal forearm fractures are among the most common upper limb fractures in all ages, and many classifications have been proposed to describe them. Recently, a new version of AO/OTA classification was proposed. The aim of this study is to use the AO/OTA 2018 classification to report the epidemiology of distal forearm fractures in adults treated at a single center. Methods: A retrospective analysis of the initial radiographs obtained from cases of distal forearm fractures in an orthopedic emergency room at a single tertiary hospital. Results: Three hundred twenty-two cases were studied, aged 50.35 ± 18.98 years, 55.3% were female and 44.7% were right-sided. Type 2R3A, 2R3B and 2R3C fractures corresponded to 32.3%, 18.0% and 48.4% of the cases, respectively. Distal ulnar fracture was present in 41.9%. There was a correlation between age and sex: 78.3% of the subjects aged under 30 years were male, and 80.6% of those aged over 60 years were female (p<0.001). Conclusion: The most common type of radial fractures was 2R3C, and the most common type of ulna fracture was 2U3A1.1. There was a correlation between age and sex. Level of evidence IV, Case-series.

scholarly journals Management of Juvenile Hallux Valgus Deformity: the role of combined Hemiepiphysiodesis

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Ming-Hung Chiang ◽  
Ting-Ming Wang ◽  
Ken N. Kuo ◽  
Shier-Chieg Huang ◽  
Kuan-Wen Wu
Keyword(s):  
Hallux Valgus ◽  
Skeletal Maturity ◽  
Proximal Phalanx ◽  
Case Series ◽  
Large Degree ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Hallux Valgus Deformity ◽  
The Mean

Abstract Background This study aimed to investigate the efficacy of percutaneous hemiepiphysiodesis for gradual correction of symptomatic juvenile hallux valgus (HV) deformity. Methods Between 2012 to 2014, 24 patients with symptomatic juvenile HV were treated by combined percutaneous medial drilling hemiepiphysiodesis of the first proximal phalanx and lateral transphyseal screw hemiepiphysiodesis of the first metatarsal at our institution. Twenty-one of 24 patients fulfilled inclusion criteria had a complete radiological and clinical follow-up of at least 2 years. Preoperative and postoperative radiographs of the feet were reviewed for measurements of hallux valgus angle (HVA), intermetatarsal angle (IMA), proximal metatarsal articular angle (PMAA), proximal phalangeal articular angle (PPAA), and metatarsal length ratio (MTLR). Clinical outcomes were assessed using the AOFAS hallux metatarsophalangeal-interphalangeal score. Results The study included 21 consecutive patients (37 ft) for analysis. The mean age at surgery was 12.0 years (SD = 1.3) and mean follow-up after surgery was 35.1 months (SD = 6.0). With the data available, the HV deformity improved in terms of the reduction of HVA by a mean of 4.7 degrees (P < .001) and the reduction of IMA by 2.2 degrees (P < .001). The PMAA and PPAA also improved significantly in the anteroposterior plane; however, the PMAA difference was insignificant in lateral plane as expected. The mean difference in the MTLR was 0.00 (P = .216) which was indicative of no length discrepancy between first and second metatarsals. The AOFAS score increased from 68.7 to 85.2 (P < .001). In correlation analysis, time to physeal closure was significantly correlated with the final HVA change (r = −.611, P = .003). Conclusion Although combined hemiepiphysiodesis does not create a large degree of correction as osteotomy, yet it did improve HV deformity with adequate growth remaining in our series. It is a procedure that can be of benefit to patients with symptomatic juvenile HV from this minimal operative approach before skeletal maturity. Level of evidence Level IV, retrospective case series.

Correction of Hallux Valgus Interphalangeus With an Osteotomy of the Distal End of the Proximal Phalanx (Distal Akin Osteotomy)

2016 ◽  
Vol 38 (2) ◽  
pp. 153-158 ◽  
Author(s):  
Robert Vander Griend
Keyword(s):  
Hallux Valgus ◽  
Proximal Phalanx ◽  
Case Series ◽  
Wedge Osteotomy ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Intraoperative Complication ◽  
Hallux Valgus Interphalangeus ◽  
Akin Osteotomy

Background: Operative correction of a symptomatic hallux valgus interphalangeus (HVI) deformity is often achieved with an osteotomy at the proximal end of the proximal phalanx (Akin osteotomy). However, the apex of the typical HVI deformity (center of rotation angle) is at the interphalangeal joint of the hallux. This study was done to evaluate the results of performing a medial closing wedge osteotomy at the distal end of the proximal phalanx. Methods: Thirty-three patients (33 feet) underwent an osteotomy at the distal end of the proximal phalanx for correction of HVI. All of the patients had other forefoot deformities which were corrected at the same time. Eight of these were revision procedures of prior forefoot operations. The length of follow-up was determined by the associated procedures with a minimum follow-up of 4 months. Results: The preoperative hallux valgus interphalangeus angle averaged 16 degrees of valgus (range 7-32 degrees) and was corrected to an average of 2 degrees of valgus (range 5 degrees valgus to 5 degrees varus). All of the patients were satisfied with the postoperative appearance and function of the first toe. Because of simultaneous correction of numerous other forefoot problems, it was not possible to specifically isolate or evaluate the effects and benefits of this osteotomy using outcomes measures. There was one intraoperative complication resulting in a fracture extending into the adjacent IP joint. Conclusions: Correction of an HVI deformity can be achieved with an osteotomy at the distal end of the proximal phalanx. This was a safe technique with few complications and with good results in terms of both correction and patient satisfaction. Level of Evidence: Level IV, retrospective case series.

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database

2020 ◽  
Vol 48 (10) ◽  
pp. 2353-2359
Author(s):  
Kyle R. Sochacki ◽  
Kunal Varshneya ◽  
Jacob G. Calcei ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Case Series ◽  
Meniscal Repair ◽  
International Classification Of Diseases ◽  
Outpatient Setting ◽  
Complication Rates ◽  
Level Of Evidence ◽  
National Insurance ◽  
Insurance Database

Background: Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series. Purpose: To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database. Study Design: Cohort study; Level of evidence, 3. Methods: A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05. Results: A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery ( P < .001), meniscal transplantation ( P = .005), or total knee arthroplasty ( P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001). Conclusion: Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.

Percutaneous Drilling of Symptomatic Accessory Navicular in Young Athletes

2005 ◽  
Vol 33 (4) ◽  
pp. 531-535 ◽  
Author(s):  
Shoichiro Nakayama ◽  
Kazuya Sugimoto ◽  
Yoshinori Takakura ◽  
Yasuhito Tanaka ◽  
Ryoji Kasanami
Keyword(s):  
Symptomatic Relief ◽  
Proximal Phalanx ◽  
Case Series ◽  
Bone Union ◽  
Type Ii ◽  
Great Toe ◽  
Young Athletes ◽  
Level Of Evidence ◽  
Accessory Navicular ◽  
Tarsal Navicular Bone

Background Results of percutaneous drilling for symptomatic type II accessory tarsal navicular bone are not determined. Hypothesis Percutaneous drilling of accessory navicular synchondrosis will induce or accelerate bone union between the accessory and primary navicular bones. Bone union of the synchondrosis leads to symptomatic relief. Study Design Case series; Level of evidence, 4. Methods Thirty-one feet of 29 patients with type II accessory tarsal navicular treated by percutaneous drilling were reviewed. Results Twenty-four feet (77.4%) were assessed as excellent, 6 (19.4%) as good, and 1 (3.2%) as fair. No feet were assessed as poor. Bone union was obtained in 16 (80%) of the 20 feet when the proximal phalanx of the great toe was immature and in 2 of the 11 feet when it was mature. Conclusion Percutaneous drilling of the synchondrosis was effective for a symptomatic type II accessory navicular, especially in patients with immature proximal phalanx of the great toe.

scholarly journals Risks and Complications Associated With Intra-articular Arthroscopy of the Knee and Shoulder in an Office Setting

2019 ◽  
Vol 7 (9) ◽  
pp. 232596711986984 ◽  
Author(s):  
Sean McMillan ◽  
Anikar Chhabra ◽  
Jeffrey D. Hassebrock ◽  
Elizabeth Ford ◽  
Nirav H. Amin
Keyword(s):  
Case Series ◽  
Major Complication ◽  
Urgent Care ◽  
Minimal Risk ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Office Setting ◽  
Patients Âgés ◽  
Lump Sum ◽  
Diagnostic Arthroscopy

Background: Classically, arthroscopy has been considered one of the diagnostic gold standards for assessing intra-articular knee and shoulder abnormality. Purpose: To assess the risks associated with in-office needle arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: A retrospective case series analysis was performed by evaluating consecutive diagnostic needle arthroscopies performed by 13 physicians at 13 independent institutions. The findings of both major and minor complications were reported by each of the 13 surgeons based on office documentation. The data were analyzed as a lump sum of both knee and shoulder cases and then subdivided and examined separately. The patients’ ages ranged from 14 to 78 years, and no statistical difference was noted between the numbers of men and women. A major complication was defined as infection, chondral toxicity, or the need for alternative treatment at an urgent care or emergency room secondary to the procedure. Minor complications were defined as a vasovagal event, pain that persisted after 24 hours, or the need for crutches or sling postprocedure. Results: Of the 1419 cases, no major complications were reported. The overall rate of vasovagal events was 1.9% for all procedures (1.6% in knees, 3% in shoulders). Persistent pain longer than 24 hours postprocedure was reported in 0.3% of cases. No patient required crutches or a sling. Postarthroscopy magnetic resonance imaging was needed in 1.4% of cases. No device failures were reported. Conclusion: Previous literature has evaluated the efficacy, sensitivity, and specificity of in-office diagnostic arthroscopy, and this study validates needle arthroscopy as safe in the office setting, with minimal risk of major or minor complications.

scholarly journals Epidemiological profile of patients undergoing surgical treatment of ankle fractures in a tertiary hospital

2018 ◽  
Vol 12 (3) ◽  
Author(s):  
Cleiton Francisco Piccini ◽  
Gaston Endres ◽  
João Marcus Do Prado ◽  
Mateus Breitenbach Scherer
Keyword(s):  
Postoperative Complications ◽  
Case Series ◽  
Tertiary Hospital ◽  
High Energy ◽  
Ankle Fractures ◽  
Definitive Treatment ◽  
Level Of Evidence ◽  
Early Postoperative Complications ◽  
The Mean ◽  
Epidemiological Profile

Objective: To evaluate the epidemiological profile of ankle fractures treated surgically in a tertiary hospital.Methods: A retrospective epidemiological study was performed. The medical records of patients with ankle fractures who underwent surgery between January and December 2017 were reviewed. The parameters assessed included age, gender, injured side, exposure (open vs closed), Arbeitsgemeinschaft für steosynthesefragen (AO) fracture classification, trauma mechanism, time to definitive treatment, and early postoperative complications. Results: The male gender was predominant (64.6%). Twenty-two fractures (50%) resulted from traffic accidents, 16 (36.4%) of which involved a motorcycle. The mean age of these patients was 28.25 years. The AO 44-B ankle fracture was the most common injury (70.4%). Eight (18.2%) wereopen fractures. The mean time to definitive treatment was 5.9 days. Early postoperative complications occurred in two patients (4.5%). Conclusion: Ankle fractures treated in a tertiary hospital affect young victims of high-energy accidents, mainly involving motorcycles. Level of Evidence IV; Therapeutic Studies; Case Series.

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