Nonpathological phalangeal fractures in cattle: 17 cases (2004–2020)

OBJECTIVE To characterize clinical findings and outcomes for cattle with nonpathological phalangeal fractures. ANIMALS 17 cattle with nonpathological phalangeal fractures. PROCEDURES Medical records of a teaching hospital were reviewed to identify cattle treated for nonpathological phalangeal fracture between May 2004 and May 2020. Information extracted from the records of study-eligible animals included signalment, history, clinical and diagnostic imaging findings, treatment, and survival to hospital discharge. Long-term outcome was assessed by telephone communication with owners. RESULTS 9 bulls and 8 heifers or cows (age range, 1 to 7 years) of various breeds and uses were evaluated. Five of the 9 bulls were bucking stock, which were overrepresented in the study population. Seven animals had 8 distal phalanx fractures; 10 animals had 11 proximal phalanx fractures. Eight animals were treated by application of a hoof block on the unaffected adjacent digit, 7 animals were treated with a distal limb (n = 6) or transfixation pin (1) cast in addition to a hoof block, 1 animal was treated with a hoof trim to elevate and alleviate weight bearing on the affected digit, and 1 animal was euthanized immediately after diagnosis. Sixteen animals survived to hospital discharge. Follow-up was obtained for 12 animals, of which 9 returned to functionable use and 3 were culled. CLINICAL RELEVANCE Results suggested cattle with a nonpathological phalangeal fracture have a favorable prognosis for return to function following application of a hoof block to the unaffected adjacent digit with or without a distal limb cast.

Evaluation of the role of platelet gel in promoting healing of phalangeal fractures after fixation by Kirschner wires

Background Autologous Platelet gel may become an ideal autologously prepared biologic blood-derived product that can be exogenously applied to a diversity of tissues, in which it releases high concentrations of platelet growth factors that enhance healing. Aim of the Work to evaluate the role of platelet gel in promoting healing in phalangeal fractures. Patients and Methods This study was conducted on 20 Patients were operated either by general or local anesthesia in a prospective interventional study for: evaluation the role of platelet gel in promoting healing of phalangeal fractures after fixation by Kirschner wires. Results In this study: clinical and radiographic signs of healing at 12wks were achieved in 70% of studied patients and 16wks were achieved in 30% of studied patients and early improvement of swelling and tenderness. Conclusion The use of Autologous platelet gel in phalangeal fractures after fixation by Kirschner wires gives a significant improvement quickly over the periods according to swelling, tenderness and x-ray healing So decrease recovery time and return to work and activities.

Management and Treatment of Wounds by Projectile from a Firearm in Hand in the Plastic and Reconstructive Surgery Service of the Central Military Hospital in Two Years

Introduction: Gunshot wounds are a major cause of morbidity and lead to serious socioeconomic problems. Wounds often causing severe functional sequelae. Therefore, it is vitally important to provide proper management of these wounds. OBJECTIVES: Define the treatment of gunshot wounds at the Central Military Hospital in the period from March 2019 to March 2021. Material and Methods: It is a descriptive, retrospective, observational study, RESULTS: Patients who fulfilled the diagnosis presented 3 metacarpal fractures (27.27%), 2 metacarpal and phalangeal fractures (18.18%), 2 fractures of phalanges (18.18%), 1 carpal + metacarpal fractures (9.09%), 3 with injury only to skin cell tissue without evidence of fractures (27.27%). Therapeutic management: 3 patients received external fixator, 2 ORIF, 1 external fixator + ORIF + inguinal flap + bone graft, 1 external fixator + bone graft + ORIF, 0 wound closure, 4 management with wet therapy, CONCLUSIONS: The wounds By firearm in hand are frequent injuries, which merit immediate treatment. This depends on the complexity of the injury for a speedy recovery and integration into the workplace.

Cost Comparison of Kirschner Wire Versus Intramedullary Screw Fixation of Metacarpal and Phalangeal Fractures

Background Intramedullary screw fixation is a relatively new technique for fixation of metacarpal and phalangeal fractures. The objective of this study was to compare health care–associated costs and outcomes for intramedullary screw versus Kirschner wire (K-wire) fixation of hand fractures. Methods A retrospective review of patients undergoing intramedullary screw fixation of hand fractures at a single center during 2016-2019 inclusive was conducted. Health care–associated costs were compared with age-matched and fracture pattern–matched controls who underwent K-wire fixation. Results Fifty patients met the study inclusion criteria, incorporating 62 fractures (29 K-wire, 33 intramedullary screw fixation). The median age was 34.6 years (18.0-90.1 years). There was no significant difference in primary operative costs (£1130.4 ± £162.7 for K-wire vs £1087.0 ± £104.2 for intramedullary screw), outpatient follow-up costs (£958.7 ± £149.4 for K-wire vs £782.4 ± £143.8 for intramedullary screw), or total health care–associated costs (£2089.1 ± £209.0 for K-wire vs £1869.4 ± £195.3 for intramedullary screw). However, follow-up costs were significantly lower for the uncomplicated intramedullary screw cohort (£847.1 ± £109.1 for K-wire vs £657.5 ± £130.8 for intramedullary screw, P = .05). Subgroup analysis also revealed that overall costs were significantly higher for buried K-wire techniques. Complication rates, time to return to active work, and Disabilities of the Arm, Shoulder, and Hand scores were similar. Conclusions This study identified significantly lower outpatient follow-up costs for uncomplicated intramedullary screw fixation of hand fractures compared with K-wires, along with a trend toward lower overall health care–associated costs. In addition, buried K-wire techniques were also found to carry a significantly higher financial burden. Higher powered prospective studies are required to determine indirect costs.