One hundred eighty seven patients with dislocation and dislocation-fracture of carpal bones were treated. There were 81 patients with acute injuries and 106 patients with old ones. In 33.6% of cases injuries of carpal bones were combined with fractures of other bones forming wrist joint. In 20.3% of cases neurologic deficit was detected. Clinical manifestations, diagnosis and peculiarities of treatment were presented. Authors considered the conduction anesthesia to be the best analgetic method. In acute trauma close manual reduction was indicated. Indications for operative treatment were non-reduced dislocations and dislocation-fractures as well as impossibility of reduction of scapoid bone. In case of wrist joint instability temporary Stabilization of wrist joint by К-wires should be performed. In old injuries two-step treatment was recommended: 1st step - distraction of the wrist joint; 2nd step - open reduction of dislocation and dislocation-fracture and osteosynthesis of the scapoid bone. Good and satisfactory results were achieved in 91% of cases.
Представлена биография Аллена Бакнера Канавела-исследователя и хирурга, внесшего неоценимый вклад мирового масштаба в развитие общей хирургии и хирургии кисти.
The experience in treatment of 369 patients with stumps, shortenings and defects of finger phalanges and metacarpal bones is presented. Distraction method alone and distraction with combination of bone autoplasty were used. Thirty patients (8,1%) with amputated stumps, 77 patients (20,9%) with ununited and 93 patients (25,2%) with malunited fractures were treated using distraction only. In 42 patients (11,4%) with amputation stumps, 29 patients (7,9%) with pseudoarthroses, 31 patients (8,4%) with ununited, 28 patients (7,6%) with malunited fractures and in 39 patients (10,6%) with the defects of articular ends and metacarpal bones the distraction in combination with bone autoplasty was performed. Long term results were evaluated in 281 patients (76,1%). Good results were achieved in 163 patients (58%), satisfactory - in 111 (39,5%) and unsatisfactory - in 7 patients (2,5%).
Treatment results of 287 patients with diaphyseal fractures of basidigital bones and phalanges using stable intramedullar osteosynthesis is analyzed. There were 77 patients (26.8%) with open fractures, 110 patients (38.3%) with closed fractures, 53 patients (18.5%)) with composite fractures and 47 patients (16.4%)) with ununited and irreducible fractures. Conduction anesthesia of the median and ulnar nerves in lower third of forearm or brachial plexus in axilla was the optimum method. The technique of stable intramedullar osteosynthesis with pins was described. For the restoration of adequate wrist function in ununited and irreducible fractures as well as in composite fractures distraction was used as the first stage of treatment. After distraction of fragments with hypercorrection by 5-8 mm the intramedullar osteosynthesis was performed. Good results were achieved in 93.9% of cases.
The treatment results of 256 patients with ununited fractures and pseudoarthroses of navicular bone are presented. In 107 patients (41,8%) diagnostic mistakes were made at early stages and in 84 patients (32,8%) treatment mistakes were detected. In 65 patients (41.4%) navicular bone fractures were not diagnosed at timely radiologic examination. Two hundred four patients (79.6%) were treated with distraction device elaborated at the clinic. In ununited fractures the rate of distraction was 1 mm/day up to 6-8 mm distraction wrist joint and then fixation in device during 4 weeks was used. After the removal of the device plaster cast was applied. In pseudoarthroses the distraction rate was 1 mm/day up to 1 cm distraction of the joint with subsequent fixation for 6-8 weeks. In navicular bone fractures with displacement fragments the reduction of fragments took place in most of the cases. When reduction was not achieved the open reduction of fragments was performed after joint distraction. Good and satisfactory results were achieved in 90.2% of cases.
Ultrasonographic examination was performed in 106 patients with clinical manifestations of wrist tendon injuries and their sequelae (in 54 patients prior to specialized treatment, in 90 - in the postoperative period and in conservative treatment). In 63 patients flexor tendons, in 36 extensor tendons, in 5 both flexors and extensors were examined. In 106 patients 139 tendons (445 ultrasonographies) were examined. Real-time Sonoline SL-1 scanner (Siemens) with 5 and 7.5 MHz linear and sector transducers was used. The examination was performed in transverse and longitudinal planes both at rest and dynamics. In 75 patients (70.8%) scan allowed to correct the preoperative protocol, tactics of conservative treatment and postoperative management as well as to choose the adequate individual duration of immobilization. Techniques of ultrasonographic examination of the wrist soft tissues in tendon injuries is elaborated. Indications for ultrasonographic examination are determined and sonographic picture of fresh and old tendon injuries and their sequelae is described.
The original method of the dosed distraction with the following fixation in the apparatus of the achieved level of unloading of the radiocarpal articulation are suggested. The combination of the method with the following plaster immobilization and physiomechanotherapy allows to obtain positive results in 86% of the cases.
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