Kienböck’s disease is a rare disease described as progressive avascular osteonecrosis of the lunate. The typical manifestations include a unilateral reduction in wrist motion with accompanying pain and swelling. Besides recent advances in treatment options, the etiology and pathophysiology of the disease remain poorly understood. Common risk factors include anatomical features including ulnar variance, differences in blood supply, increased intraosseous pressure along with direct trauma, and environmental influence. The staging of Kienböck’s disease depends mainly on radiographic characteristics assessed according to the modified Lichtman scale. The selection of treatment options is often challenging, as radiographic features may not correspond directly to initial clinical symptoms and differ among age groups. At the earliest stages of Kienböck disease, the nonoperative, unloading management is generally preferred. Patients with negative ulnar variance are usually treated with radial shortening osteotomy. For patients with positive or neutral ulnar variance, a capitate shortening osteotomy is a recommended option. One of the most recent surgical techniques used in Stage III Kienböck cases is vascularized bone grafting. One of the most promising procedures is a vascularized, pedicled, scaphoid graft combined with partial radioscaphoid arthrodesis. This technique provides excellent pain management and prevents carpal collapse. In stage IV, salvage procedures including total wrist fusion or total wrist arthroplasty are often required.
Introduction. Treatment of benign bone tumors and tumor-like lesions is undertaken by numerous Orthopedic surgeons worldwide. Several treatment modalities exist including curettage and bone grafting. CERAMENT is a novel bioresorbable bone substitute used for grafting. Aim. Assessment of preliminary result of treatment of benign bone tumors and tumors like lesions utilizing CERAMENT as a bone substitute. Analysis of therapeutic and diagnostic path and symptoms reported by patients with tumors and tumor-like lesions. Materials and methods. To the retrospective study 38 patients undergoing curettage and bone substitution with CERAMENT® BONE VOID FILLER were included (26% of them were females). We utilized patients’ history. Each patient had an X-ray in the twelfth month after surgery, which was analyzed using the modified Neer classification. The follow-up was 24 months. Results. The unicameral bone cyst was the most commonly encountered lesion (36.8%). Pain was the most common symptom reported (28.9%). Half of all cases were discovered accidentally on X-rays ordered for a different indication. Nearly a quarter of the cases (23.7%) were complicated by pathologic fracture. The distribution of scores in modified Neer score was as follow: SCORE I- 52.6% SCORE II- 15.8% SCORE III-10.6% SCORE IV-2.6%. Complications of procedure were noted in 18.4% of patients. 10.5% of patients had serious discharge from the operated site, 7.9% of patients had surgical wound infection. One case of recurrence was noted. Conclusions. Bone substitute – CERAMENT is suitable for use in the treatment of benign bone tumors and tumors like lesions. It is easy in application and is well tolerated by the patients. The problem is the relatively high rate of complications, mainly serous leakage from the wound.
Introduction. Carpal tunnel release (CTR) is among the most commonly performed procedures within a hand, in a day surgery setting. Studies suggest that patient concerns and emotional state may influence CTR outcomes. Aim. To determine the frequency of preoperative concerns among patients operated for carpal tunnel syndrome (CTS) and their correlation with negative emotions, socio-demographic and clinical variables. Materials and methods. A total of 72 patients (81.9% women) scheduled for CTR were included in the study. Pain, anxiety, irritability, and depression were measured using the Visual Analogue Scale (VAS) on the day of surgery. Tailor-made questionnaires were used to explore patients’ concerns and to gather socio-demographic and clinical data. Statistical analysis was performed utilizing R language. α < 0.05 was considered significant. Results. At least one concern was declared by the vast majority of patients (93.1%). Postoperative pain was the most prevalent concern, declared by 49.3% of participants. “Outcomes will not meet my expectations” was a concern for 43.3% of participants. Concern related to intraoperative complications was declared by 34.3% of participants. Patients scheduled for CTR had high mean VAS scores of anxiety and irritability and low score of depression. Anxiety reached the highest level among measured variables. Patients who declared postoperative pain had statistically significantly higher levels of pain, anxiety, irritability, and depression than patients without this concern. Concern that surgery outcomes will not meet patient’s expectations was declared statistically significantly more frequently by patients with any surgery in history. Conclusions. Preoperative concerns among patients operated for carpal tunnel syndrome are extremely prevalent. Those concerns are accompanied by a high level of negative emotions. Therefore assessment of emotional status, addressing particular concerns, and tailored preoperative intervention, all are of crucial importance. A meticulous approach to postoperative pain and patients’ expectations regarding outcomes seem to be essential. The mentioned strategy may positively influence patients’ comfort and surgery outcomes.
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.