Purpose of review
The purpose of this review is to summarize and clarify the current framework for treating tibial spine avulsion fractures (TSAFs). We will discuss how these fractures are classified both on plain radiographs and MRI as well as report the incidence of concomitant soft tissue injury, an important consideration that guides treatment. We will also compare guidelines for nonsurgical versus surgical treatment and summarize frequently used surgical techniques. Finally, we will review outcomes following treatment, including common complications.
Recent findings
Although TSAFs only constitute 2–5% of all pediatric knee injuries, the incidence is increasing. A recently developed MRI-based system for evaluating TSAFs is another tool that aids in the treatment of these injuries.
Summary
TSAFs can be classified using plain radiographs as well as MRI. Type I fractures are usually treated with immobilization whereas type II fractures typically undergo an initial attempt at closed reduction followed by arthroscopic or open reduction and fixation if needed. Type III fractures are indicated directly for arthroscopic surgery and both suture and screw fixation produce good clinical outcomes. All-epiphyseal or transphyseal approaches can minimize the risk of physeal injury in skeletally immature patients. Common complications following TSAF injury and treatment are residual laxity, knee stiffness, and nonunion or malunion.
The anterior cruciate ligament is the most commonly injured ligament, with up to 10% of surgery failure. Atraumatic instability in the early postoperative period (<6 months) occurs as the result of poor surgical technique, failure of graft integration, or early mechanical overload during rehabilitation. Engineered cell therapy is a developing resource designed to increase the rate of tendon-to-bone interface healing. We describe a simple and safe technique to harvest mesenchymal stem cells by arthroscopic bone marrow aspiration from the intercondylar notch.
Background: Several factors associated with B glenoid are also linked with obstetrical brachial plexus palsy (OBPP). The purpose of this observational study was to determine the incidence of OBPP risk factors in type B patients. Methods: A cohort of 154 patients (68% men, 187 shoulders) aged 63 ± 17 years with type B glenoids completed a questionnaire comprising history of perinatal characteristics related to OBPP. A literature review was performed following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) to estimate the incidence of OBPP risk factors in the general population. Results: Twenty-seven patients (18%) reported one or more perinatal OBPP risk factors, including shoulder dystocia (n = 4, 2.6%), macrosomia >4 kg (n = 5, 3.2%), breech delivery (n = 6, 3.9%), fetal distress (n = 8, 5.2%), maternal diabetes (n = 2, 1.3%), clavicular fracture (n = 2, 1.3%), and forceps delivery (n = 4, 2.6%). The comparison with the recent literature suggested that most perinatal OBPP risk factors were within the normal range, although the incidence of shoulder dystocia, forceps and vaginal breech deliveries exceeded the average rates. Conclusion: Perinatal factors related to OBPP did not occur in a higher frequency in patients with Walch type B OA compared to the general population, although some of them were in the high normal range.
Transferencias tendíneas alrededor del hombro para paciente con secuelas de lesiones de plexo braquial Tendon transfers around the shoulder for patient with brachial plexus injury sequels
Distal Radius41S scan is considered to show more precisely the steps and rotational deviations of these fractures but is not routinely used for initial patient assessment. The objective of the present study was to determine whether CT scan is useful for planning and treating the fractures of the distal radius in adults showing the level of interobserver agreement for classifying and treating fractures, and whether CT scan changes the directions of the treatment previously indicated only with conventional radiography. Materials and Methods: Five observers with similar professional backgrounds in hand surgery evaluated the CT scans and radiographs of 36 patients with fractures of the distal radius that were distributed by a moderator in a blind form, by chance. These patients were accepted and included in the study in a trauma reference hospital in the 6-month period. A total of 180 CT scans and 180 x-rays were evaluated. Fractures were classified using the universal and Arbeitsgemeinschaft für Osteosynthesefragen (AO) methods by the observers who indicated, as well, one of the five treatments previously predetermined, evaluating randomly the x-rays and CT scans on both situations. Interobserver agreement was researched for each one of the classifications and for the indication of treatment with the use of CT scan and x-ray thereafter. Results: The Kappa evaluation showed the same range of agreement (0.20-0.39) on both examinations. There were fewer indications of nonsurgical treatment (23 indications with CT scan against 41 with the x-ray) and an increased number of indications of more complex forms of treatment when CT scan was analyzed. Conclusions: It is concluded that CT scan and radiography have similar levels of interobserver agreement for classification and indication of treatment of fractures of the distal end of the radius. CT scan showed to be a useful imaging method, besides the use of radiography, for initial evaluation and also for indication of the treatment of fractures of the distal end of the radius. CT changed this indication in a significant way when compared with x-ray. Although some studies recommend CT only for indicating the preferred treatment option after the surgical decision, our study demonstrated that tomography evaluation is important even before the indication of the treatment because it adds more information for classification, and therefore, to change treatment planning, which may be a great benefit to reduce the degenerative processes and other complications.
Background:The volar locking plate (VLP) has been widely used over the past 2 decades in patients with distal radius fractures (DRFs). However, flexor pollicis longus (FPL) ruptures are a well-known postoperative complication of using the VLP system, although the incidence of tendon ruptures following VLP fixation remains unclear. The purpose of the present study was to assess the frequency of FPL rupture on a large scale in patients with DRFs who were treated with the VLP system. Materials and Methods: A questionnaire was ad...
HAND 11(1S) system in January 2016. The unit received an average of 7 referrals on NORSE each day with over 90% of the referrals being responded within 30 minutes. The quickest response was found to be within 2 minutes. NORSE has avoided lengthy telephone conversations during referrals and has helped junior doctors as well as advanced nurse practitioners to deal with emergency workload with ease. The contemporaneous record of the referral also serves to promote accuracy of clinical details and drive up the standard of care. Conclusion: The quality and accuracy of clinical information on the referrals have improved significantly. Junior doctors have been unburdened by telephone conversations, thus allowing them to focus on honing their clinical experience. The junior doctor morale has also improved since the introduction of NORSE. We recommend that NORSE may be of benefit if used in other UK centers to promote efficiency, accuracy, and contemporaneous record of health care interaction.
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