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Gadani A, Rabhi C, Forli A. Radial nerve lesion after medial epicondyle osteosynthesis in a pediatric patient: A rare complication of surgery. Hand Surg Rehabil 2023; 42:451-454. [PMID: 37482276 DOI: 10.1016/j.hansur.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
Fractures of the medial epicondyle are relatively common in children and may be associated with nerve lesion, especially in case of displacement. Incarceration of the ulnar nerve in the fracture site is feared in Watson-Jones stage II, rarely directly related to osteosynthesis. Depending on the degree of fracture displacement, various osteosynthesis techniques may be used; nerve injuries are a rare but known complication of these procedures. We report a case of radial nerve injury related to pinning osteosynthesis of a medial epicondyle fracture.
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Affiliation(s)
- Anaëlle Gadani
- Pediatric Orthopedic Department, Grenoble Alpes University, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France.
| | - Camille Rabhi
- Pediatric Orthopedic Department, Grenoble Alpes University, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France
| | - Alexandra Forli
- Plastic and Reconstructive Surgery, Hand Surgery Unit, Grenoble Alpes University Hospital, 38043 Grenoble Cedex 09, France
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Saade F, Bouteille C, Obert L, Lepage D, Loisel F, Menu G. [Osteosynthesis by intramedullary headless screw in digital fractures: A retrospective scannographic and anatomical study]. ANN CHIR PLAST ESTH 2022:S0294-1260(22)00104-2. [PMID: 35902287 DOI: 10.1016/j.anplas.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/19/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Long finger skeletal fractures are common injuries. In displaced forms, surgical treatment is required. With the advent of headless cannulated screws, the technique has been simplified and allows reduction in both planes. The objective of our study was to evaluate the functional recovery of patients operated on by this technique. MATERIAL AND METHOD We conducted a retrospective single-center study between 2019 and 2022. Eleven patients were followed and 12 fractures analyzed. A radio-clinical follow-up was carried out at 1 month then at the last follow-up with an evaluation of the articular amplitudes and a quality of life score (QuickDash, QD). The time to return to professional and sporting activities, pain (EVA) was collected. An anatomical/scannographic evaluation was performed to assess tendon and cartilage damage. RESULTS At the last follow-up, the average global flexion was 266° and the extension was total. An average QD score of 15.9 and a Jamar force of 106% compared to the healthy side were observed. The return to physical and professional activities was earlier and the pain quickly tolerable. No secondary displacement was objectified and all were consolidated at the last follow-up, without malunion. No patient had been operated on secondarily. CONCLUSION This technique seems to be a safe and non-traumatic. It allows a faster return to sports and professional activities with fewer complications and no need to remove the material.
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Affiliation(s)
- F Saade
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France.
| | - C Bouteille
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - L Obert
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - D Lepage
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - F Loisel
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - G Menu
- Orthopaedics, traumatology, plastic & reconstructive surgery unit, Hand surgery Unit, University Hospital J.-Minjoz, Besançon, France; NanoMedecine Research Unit, university of Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
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Acar E. Management of Allen type III nail bed injuries and distal phalangeal fractures with and without fixation. Hand Surg Rehabil 2021; 40:477-483. [PMID: 33848652 DOI: 10.1016/j.hansur.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/17/2022]
Abstract
For combined nail bed injuries and distal phalangeal fractures, fixation may be indicated when there is fracture instability and if a K-wire can be successfully placed in the fracture fragments. We determined the outcomes when these criteria were applied for patients with Allen type III injuries without substantial tissue loss. We retrospectively analyzed 57 patients who had surgery for nail bed injuries with distal phalangeal fractures between October 2017 and January 2020. All patients underwent anatomical nail bed repair, and some had fracture fixation, according to specific surgical criteria. We obtained data about demographic and clinical characteristics, postoperative radiographs, complications, range of motion, and satisfaction. To achieve our primary objective, we evaluated the patient population as a whole. The median follow-up was 12 months (range, 7-21). After 90 days, all 57 patients achieved satisfactory fracture union, 54 (95%) had excellent range of motion, and 54 (95%) were either satisfied or very satisfied with the outcome. Though 6 (10%) patients had residual fracture displacement, none had complications. In patients with Allen type III fingertip injuries without substantial tissue loss, anatomical nail bed repair and triage of patients to fixation or no fixation are likely to result in excellent functional outcomes and high patient satisfaction. However, fixation can neither be recommended nor rejected for these injuries based on this study alone. Level of evidence: IV.
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Affiliation(s)
- E Acar
- Department of Orthopedics and Traumatology, Hand and Upper Extremity Surgery Division, Ankara City Hospital, Üniversiteler Caddesi, Bilkent Bulvarı No:1, 06800 Çankaya/Ankara, Turkey.
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Jorquera-Aguilera R, Mathoulin C. Effectiveness of early versus delayed motion in patients with distal radius fracture treated with volar locking plate: A systematic review and meta-analysis. Hand Surg Rehabil 2020; 40:6-16. [PMID: 33144249 DOI: 10.1016/j.hansur.2020.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/04/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
The aim of this study was to determine the effectiveness of early versus delayed motion on the functional outcomes in patients with distal radius fracture (DRF) treated with a volar locking plate. A systematic review and meta-analysis of randomized clinical trials was performed. An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria included randomized clinical trials that compared the effect of early versus delayed motion on wrist and/or upper limb function, pain, grip strength, and wrist range of motion in subjects older than 18 years with DRF treated with a volar locking plate. Five clinical trials were included that met the eligibility criteria for the quantitative synthesis. At 6 weeks, the PRWE questionnaire showed a mean difference (MD) of -10.6 points (p < 0.001), the MD was -11.1 points for the DASH questionnaire (p < 0.001), -0.56 cm for pain on VAS (p = 0.01), 5.0 kg for grip strength (p = 0.01), 12.5 degrees for wrist flexion (p = 0.07), and 12.8 degrees for wrist extension (p = 0.05). All differences favored the early motion treatment. At 3 months of follow-up, only the DASH, pain on VAS, and grip strength showed significant differences in favor of early motion. At 1 year of follow-up, none of the variables studied were different between groups. In the short term, there was moderate to high evidence of clinically and statistically significant differences in the functional outcomes in favor of early versus delayed motion in patients with DRF treated with a volar locking plate. But these differences were not observed at 1 year of follow-up. PROSPERO registration no.: CRD42020158706.
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Affiliation(s)
- H Gutiérrez-Espinoza
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Echaurren Street 140, 2nd floor, Santiago, Chile; School of Health Sciences, Physiotherapy Department, Universidad Gabriela Mistral, Ricardo Lyon Avenue 1177, Santiago, Chile.
| | - F Araya-Quintanilla
- Faculty of Health Sciences, Universidad SEK, Fernando Manterola Street 0789, Santiago, Chile
| | - C Olguín-Huerta
- Rehabilitation in Health Research Center (CIRES), Universidad de las Americas, Echaurren Street 140, 2nd floor, Santiago, Chile
| | - R Gutiérrez-Monclus
- Orthopedic Surgeon, Instituto Traumatológico, San Martin Street 771, Santiago, Chile
| | - R Jorquera-Aguilera
- Orthopaedic Surgeon, Clínica Indisa, Santa Maria Avenue 1810, Santiago, Chile
| | - C Mathoulin
- Institut de la Main, Clinique Bizet, 23, rue Georges Bizet, Paris, France
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Gauci MO, Lenoir H, Waitzenegger T, Andrin J, Lazerges C, Coulet B, Chammas M. [Extra-articular distal radius fractures in young adults]. Hand Surg Rehabil 2016; 35S:S44-S50. [PMID: 27890211 DOI: 10.1016/j.hansur.2016.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/23/2016] [Accepted: 03/03/2016] [Indexed: 11/17/2022]
Abstract
Extra-articular distal radius fractures in young active patients are typically the result of sport injuries or traffic accidents. Displaced fractures are less well tolerated in young patients than in older people, especially in terms of dorsal tilt and radial shortening. Non-surgical treatment is only indicated when the fracture is minimally or not displaced. No fracture fixation method is superior to another, however, the treatment goal is a rapid return to previous activities.
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Affiliation(s)
- M-O Gauci
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - H Lenoir
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - T Waitzenegger
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - J Andrin
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - C Lazerges
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - B Coulet
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - M Chammas
- Service de chirurgie de la main et du membre supérieur, chirurgie des nerfs périphériques, hôpital Lapeyronie, CHU de Montpellier, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France.
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Lebrun C. [Internal fixation of the distal radius: Medical liability considerations]. Hand Surg Rehabil 2016; 35S:S162-S165. [PMID: 27890205 DOI: 10.1016/j.hansur.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/11/2016] [Accepted: 04/21/2016] [Indexed: 11/16/2022]
Abstract
Fixation of distal radius fractures is now the primary surgical procedure leading to medical liability claims for surgeons dealing with injuries to the upper limb. The main reasons for incrimination are complex regional pain syndrome and an unfavorable progression toward malunion. Infectious problems are relatively rare and, in general, well controlled. The associated capsule and ligament damage can be underestimated at the time of the initial assessment, which points to the need for complementary imaging in case of doubt. The prevention of claims inevitably requires a judicious choice of the fixation technique, which is adapted to the anatomical fracture type and to the patient. The best defense is a complete medical record, with emphasis on traceable information.
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Affiliation(s)
- C Lebrun
- Cabinet Branchet, 34, avenue du Granier, 38240 Meylan, France.
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Abid H, Shimi M, El Ibrahimi A, El Mrini A. Articular fracture of the base of the thumb metacarpal: Comparative study between direct open fixation and extrafocal pinning. ACTA ACUST UNITED AC 2015; 34:122-5. [PMID: 25890867 DOI: 10.1016/j.main.2015.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 12/27/2014] [Accepted: 01/05/2015] [Indexed: 11/20/2022]
Abstract
The treatment of intra-articular fractures of the base of the first metacarpal bone should aim to anatomically reduce the articular surface, restore the initial length of the first metacarpal and preserve the opening of the first web space. These objectives appear to be achievable with a well-conducted surgical treatment. In a retrospective study, we reviewed a series of 38 cases, which compared open reduction and internal fixation (ORIF) and extrafocal pinning to determine which option provided the best reduction and functional recovery in young, manual workers. Direct fixation was better at restoring the configuration of the joint, regardless of the age and sex of the patients and the fracture type. This complete reduction is associated clinically with better function. Thumb opposition was statistically better in fractures treated by ORIF. Thumb retroposition was better in the cases treated by ORIF, but not significantly. ORIF appears the best technique for treating intra-articular fractures of the base of the first metacarpal, as it results in better functional recovery.
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Affiliation(s)
- H Abid
- Service de chirurgie ostéo-articulaire B4, CHU Hassan II, immeuble 87, appartement 4, rue Sidney, Hay Ouafae 2, Narjiss, Fès, Morocco.
| | - M Shimi
- Service de chirurgie ostéo-articulaire B4, CHU Hassan II, immeuble 87, appartement 4, rue Sidney, Hay Ouafae 2, Narjiss, Fès, Morocco
| | - A El Ibrahimi
- Service de chirurgie ostéo-articulaire B4, CHU Hassan II, immeuble 87, appartement 4, rue Sidney, Hay Ouafae 2, Narjiss, Fès, Morocco
| | - A El Mrini
- Service de chirurgie ostéo-articulaire B4, CHU Hassan II, immeuble 87, appartement 4, rue Sidney, Hay Ouafae 2, Narjiss, Fès, Morocco
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Prade V, Seguin P, Boutet C, Alix T. [Outcome of endoscopically assisted surgical treatment of mandibular condyle fractures: a retrospective study of 22 patients]. ACTA ACUST UNITED AC 2014; 115:333-42. [PMID: 25458598 DOI: 10.1016/j.revsto.2014.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 07/10/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The condylar region is a frequent localization of mandibular fractures; there are various types of management. Mini-invasive endoscopic surgery is an alternative to open reduction. We had as goal to evaluate the outcome of this technique. MATERIAL AND METHODS We performed a monocentric retrospective study of patients consecutively operated for a condylar fracture (type II to V in the Spiessl and Schroll classification) with intraoral route and endoscopic assistance, during 30 months. We assessed the functional and radiological outcomes, and the complications. RESULTS Twenty-two patients (25 fractures) were included. Seventeen patients (19 fractures) could be followed (mean follow-up: 16.7 months). The mean values were: interincisal opening, 45mm (±8.4); protrusion, 8.3mm (±1.9); ipsilateral excursion of the jaw: 8.6mm (±2); contralateral excursion: 8.7mm (±4). Three routes were used combined with a preauricular approach. The fracture reduction was good for 10 of the 19 fractures and poor for 3. The complications were: 3 cases of infection, 1 case of fixation failure with good consolidation; for combined approaches: 2 cases of temporary facial palsy and 2 cases of Frey syndrome. DISCUSSION Endoscopic assistance for the surgical management of the fracture of mandibular condyle is a reliable technique, with a good functional outcome, and a low rate of specific complications, especially for facial nerve lesion or esthetic outcome.
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Affiliation(s)
- V Prade
- Service de chirurgie maxillo-faciale et plastique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France; Laboratoire SNA-EPIS, EA 4607, université Jean-Monnet, 42055 Saint-Étienne cedex 2, France
| | - P Seguin
- Service de chirurgie maxillo-faciale et plastique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France; Faculté de médecine, université Jean-Monnet, 42023 Saint-Étienne cedex 2, France
| | - C Boutet
- Service de radiologie, hôpital Nord, CHU de Saint-Etienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France; Groupe de recherche sur la thrombose, EA 3065, 15, rue Ambroise-Paré, 42300 Saint-Étienne, France
| | - T Alix
- Service de chirurgie maxillo-faciale et plastique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 2, France; Laboratoire SNA-EPIS, EA 4607, université Jean-Monnet, 42055 Saint-Étienne cedex 2, France; Faculté de médecine, université Jean-Monnet, 42023 Saint-Étienne cedex 2, France; CREATIS-LRMN, CNRS UMR 5220 - Inserm U1044 - université Lyon 1 - INSA Lyon, 7, avenue Jean-Capelle, 69621 Villeurbanne cedex, France.
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