Early Functional Treatment and Modern Cast Making for Indications in Hand Surgery

Cast treatment can serve both as a nonsurgical treatment option and as a means for providing postoperative protection. However, with the duration of immobilization intervals, the benefits of cast treatment, especially in hand surgery, are at risk of being outweighed by undesired drawbacks such as joint stiffening and contracture formation. In order to minimize potential complications commonly associated with cast treatment, efforts to further improve cast making must attempt to reconcile two conflicting objectives: (1) to achieve stability and rigidity at the site of injury (e.g., fracture retention) and (2) to allow free range of joint movement as early as possible. In addition, in order to assure patient compliance, modern cast treatments should aim to improve wearing-comfort of the cast. This paper describes modern cast designs for four common types hand injuries, with sample cases highlighting the clinical outcome of each treatment.

Low Invasive Internal Osteosynthesis in Fractures of Tibial Plateau

Outcomes of surgical treatment of 97 patients with intraarticular fractures of proximal tibial metaepiphysis were analyzed. In all patients internal osteosynthesis without arthrotomy and under either electro-optical transducer or arthroscopic control was performed. Cannulated screws and plates with angular stability were used for osteosynthesis. In fractures with impression of articular surface plasty of bone tissue defects using either autograft from the upper flaring portion of the ilium or -tricalcium phosphate was performed. In postoperative period partial weight bearing on the operated extremity was allowed starting from the 6th week. Complete weight bearing in fractures with impression was allowed in 10 week and in 6 weeks - in fractures without impression. Treatment results were followed up at terms from 6 to 70 months (mean - 35 months). Roentgenologic and functional evaluation was performed by Rusmussen and Resnik-Niwoyama systems. Achieved roentgenologic results were excellent in 57.7% of patients, good - in 24.7%, satisfactory - in 15.5% and unsatisfactory in 2.1% of patients. It was showed that at treatment of such fractures the application of modern fixators and arthroscopic control enabled to perform adequate reposition of the articular surface and visualize injuries of intraarticular structures. Plasty of subchondral bone defects and application of plates with angular stability eliminated the probability of secondary displacement of fragments thus creating the possibility of early functional treatment and rehabilitation.