FCA with the Xpode® yielded reasonable results for pain and function and demonstrated a fusion rate of 80 %.
A posterior approach to the elbow utilizing an olecranon osteotomy has been shown to provide excellent visualization of the distal humerus articular surface. However, many bony stabilization and fixation methods for the olecranon osteotomy are usually prominent, frequently symptomatic, and often require a second operation for removal. This paper evaluates the use of an innovative device, the olecranon sled, in fixation of olecranon osteotomies for exposure of intra-articular distal humerus fractures and provides follow-up results. A retrospective review of all patients with intra-articular distal humerus fracture treated through an olecranon osteotomy approach and fixed with an olecranon sled, between September 2008 and December 2011 was conducted. Charts and radiographs were reviewed to determine olecranon union or nonunion, presence of symptomatic hardware, and need for secondary surgery to remove symptomatic olecranon fixation. Fourteen patients were included in the study. Average clinical follow-up was 33.5 weeks (range, 6 to 118 wk). There were no olecranon nonunions. One patient underwent additional surgery for symptomatic hardware removal (7.1%). Two additional procedures were performed; 1 for revision open reduction and internal fixation of distal humerus fracture nonunion (7.1%) and 1 for release of elbow contracture (7.1%). Although follow-up is limited, the use of this device has been associated with excellent rates of olecranon union with a low rate of symptomatic hardware requiring removal.
SRN entrapment neuropathy was safely and effectively treated with neurolysis and amnion nerve wrapping in this small series. Use of this technique for perineural scar prevention warrants additional study in larger groups of patients and in other upper extremity entrapment neuropathies.
Posterior interosseous nerve entrapment is a potential cause of upper extremity muscle weakness and pain. The diagnosis may be difficult to make clinically, and electrodiagnostic tests may not identify the exact site of nerve compression. We report a case of posterior interosseous nerve entrapment in which electrodiagnostic studies suggested radial neuropathy at the level of the spiral groove, but the sonographic evaluation pinpointed the arcade of Frohse as the level of compression. The patient’s symptoms improved dramatically following surgical release of the nerve. Sonography may be a valuable, non-invasive diagnostic tool in evaluating patients with posterior interosseous nerve entrapment.
Botulinum toxin A has been described in treatment protocols for several disease processes, from primary axillary hyperhydorosis to esophageal dysfunction. It is best known for its use in plastic and dermatological practices. Botulinum toxin has a straightforward mechanism of action. The toxin inhibits acetylcholine release at the neuromuscular junction causing a chemical denervation, which ceases contractions of the muscle. With its minimal side effect profile, botulinum toxin should be considered when muscle spasm is a detriment. This case involves an injury to the hand of a patient with a history of intermittent diffuse muscle spasms. Subsequently, due to the patient's previous upper extremity muscle spasms, repeated flexor tendon repair ruptures of the index finger occurred until botulinum toxin was administered to the offending muscle. The patient has not required any additional surgical interventions for the repaired tendon and is now actively flexing all digits. This case report demonstrates how botulinum toxin can be used in a clinical scenario when decreased muscle activity is desired to promote tendon healing.Keywords Flexor tendon rupture . Botulinum toxin A . Botox . Teno fix . Flexor tendon repair Case ReportA 44-year-old right-hand-dominant male presented to the emergency room with injuries sustained to his left hand owing to a table saw laceration across his palm. His exam and operative findings noted the following: fractures of the index and small finger proximal phalanges, zone III flexor digitorum superficialis and profundus tendon lacerations to the index, zone III flexor pollicis longus tendon laceration, and zone III flexor tendon injuries to the small finger. Concurrent injuries also included digital nerve lacerations to the thumb, index, and small finger. There were vascular lacerations of the digital artery to the small and index fingers.His past medical history is significant due to an ongoing neurological dysfunction from a prior traumatic injury. This prior injury has left the patient with intermittent diffuse muscle spasms. His medications for this condition include neurontin 600 mg four times a day, baclofen 20 mg three times a day, morphine 30 mg three times a day, and celebrex 200 mg twice a day. Despite this regiment of medications, he describes ongoing symptoms of muscle spasm including his injured extremity. His past surgical history is also significant for a prior left middle finger amputation through the level of the middle phalanx.Initial emergent operative management incorporated irrigation and debridement along with repairs of the tendon lacerations to the thumb, index, and small fingers. Tendon repairs were carried out using a four-strand core suture technique augmented with a 6-0 prolene epitendinous suture. The bony fractures were stabilized with 0.045 Kirshner wires. Repairs to the lacerated digital nerves and arteries were also performed. Finally, a protective dorsal block plaster splint was applied.The patient was examined postoperatively in a routine fashion....
Objectives: To determine the frequency of abnormal serum chemistries and whether they provide clinically useful information regarding trauma patients. To identify clinical criteria associated with critical serum chemistry values (CSCVs). Methods:The records of all trauma patients admitted to one urban, Level I Trauma Center were retrospectively reviewed for the period (July 1-December 31,1989). All trauma patients who had had serum chemistry determinations at hospital admission and at least once more prior to discharge were studied. The CSCVs were determined by a panel of experts prior to record review. Serum chemistry values, patient demographics, mechanisms of injury, and outcomes were statistically analyzed.Results: Most (814/913; 89%) trauma patients had abnormal serum chemistry values. However, only 54/913 (6%) had CSCVs and only six of these CSCVs had prompted a change in resuscitation or treatment (therapeutic K + infusions). Age > 50 years, a history of hypertension therapy, and a Glasgow Coma Scale score 5 10 were associated with CSCVs; and CSCVs were correlated with increased mortality and critical care unit admission. Conclusion:Routine-admission serum chemistry values, while frequently abnormal for major trauma patients, generally do not provide clinically useful information in the resuscitation and treatment of trauma patients. Hypoglycemia and metabolic acidosis were more rapidly determined using bedside glucose determination and arterial blood gas evaluation. The routine-admission serum chemistry panel described in the study lacked utility for most trauma patients. Selective chemistry panel ordering should be used at the time of hospital admission for major trauma patients.Acad. Emerg. Med. 1995; 2:190-194.
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