SUMMARYWe present a case of dislocations of the carpometacarpal joints without associated fractures. Although carpometacarpal injuries are relatively uncommon, it is rare for multiple carpometacarpal dislocations to occur without associated fractures. The injury is difficult to diagnose because of swelling of the hand. A lateral radiograph of the wrist has been found to be mandatory to its precise diagnosis if suspected.In the case presented here early diagnosis and closed manipulation in the accident and emergency (A&E) department resulted in a good outcome.Key words: carpometacarpal dislocations, diagnosis, investigation, management, radiographs CASE REPORT cast with the wrist in a neutral position was applied. A check radiograph showed a satisfactory reduction.The patient was reviewed after 1 week when he was comfortable in his cast. A further 2 weeks later he returned for follow-up having removed his own cast. He had a full range of painfree movements in his hand and wrist. A 20-year-old construction worker presented to the A&E department complaining of pain in his right hand and inability to move his fingers. He stated that he had punched a wall in anger. He admitted to having consumed alcohol. DISCUSSIONOn examination there was swelling on the dorsum of his right hand. Active movements were not possible due to pain but limited passive movement of the fingers were present. There was no neurovascular deficit in the fingers. A provisional diagnosis of fracture of the metacarpals was made. The routine postero-anterior and oblique radiograph of the hand did not show any fracture but made us suspicious of an injury at the carpometacarpal joints (Fig. 1). A lateral radiograph of the wrist was requested.The lateral radiograph of the wrist clearly demonstrated carpometacarpal dislocations of the index, middle, ring and little fingers but no fractures were seen (Fig. 2). The dislocations were easily reduced by linear traction of the fingers under axillary nerve block. The reductions were stable. A below elbow
The aim of this study was to assess whether autonomic dysfunction associated with carpal tunnel syndrome (CTS) can be assessed quantitatively with a (modified) biro test of finger sweating. Twenty-six hands of 16 patients with CTS were compared with 30 hands of 15 normal subjects. A device was constructed to measure the angle from the horizontal at which a biro slips from the finger (the critical angle). In the control subjects, no significant difference was found in the critical angle between the little and index fingers in either hand. By comparison, in subjects with CTS, the critical angle was significantly lower in the index finger than in the little finger, the mean difference being 8.65 degrees , indicating a quantifiable and significant difference of sweating of the median nerve-innervated index finger.
The optimum method of managing perforated peptic ulcers remains controversial, particularly when associated with the ingestion of ulcerogenic drugs. We reviewed the notes for a series of patients treated surgically by simple closure of drug-induced peptic ulcer perforations to identify whether simple closure and omental patching alone was an effective treatment in these patients. We also wrote to their primary care physicians to obtain details of any further dyspeptic symptoms, continued ulcerogenic drug use, or the need for further antiulcer therapy or surgery. Thirty patients underwent simple closure and omental patching. The overall mortality rate was 27% but increased to 38% in patients older than 80 years. Aspirin was implicated in perforations in only seven cases, and steroids alone were not implicated in any cases. Eight patients have subsequently restarted ulcerogenic drugs without further dyspeptic symptoms. We conclude that simple closure is a safe and effective means of treating perforated peptic ulcers associated with ulcerogenic drugs, even if these are restarted.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.