ACL graft length and tension change throughout knee range of motion and also depend on femoral tunnel orientation and fixation type. The use of an all-epiphyseal tunnel with suspensory fixation should be studied further for evidence of graft elongation.
Constriction band syndrome affecting the hand and importantly the thumb may require reconstruction to improve function. This case report presents a patient with auto-amputation through the proximal phalanx of the middle, index, and thumb. Microvascular reconstruction was used to perform an on-top-plasty with the remaining index finger to the thumb. The case also involved skin graft coverage, venous grafting, and tendon reconstruction. The patient presents with 12 months follow up after index procedure and 3 months after revision. She has the ability to grasp large objects. Sensation remains present in pulp of new thumb. Cosmesis subjectively improved per patient's family and physician. Strength continued to improve and reached 2 Kg of grip strength by 12 months. Microvascular on-top-plasty is a possible option for improving function in constriction hand syndrome affecting multiple digits.
Background:
This study evaluates the occurrence of orthopaedic trauma admissions in concordance with local weather variations. We hypothesized that the rate of orthopaedic trauma would be altered with daily temperature maximums (Tmax) that exceeded 90°F.
Methods:
Data were obtained from two level 1 trauma centers for adult trauma with Abbreviated Injury Scale-Extremity >1, and admission. The data collected from the National Weather Service included daily temperatures and precipitation.
Results:
There was an average of 4.0 admissions per day. Precipitation was not significantly related to admission. Tmax 80-89°F averaged 4.7 traumas per day, compared to Tmax 90-99°F averaging 4.9 per day. When Tmax was >100°F the rate dropped to 3.9 traumas per day, P<0.05.
Conclusions:
Orthopaedic trauma does increase during warmer days with the peak occurring in August. Precipitation had no overall effect. The incidence of trauma did increase with Tmax 80-99°F but dropped significantly when Tmax exceeded 100°F.
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