Essex-Lopresti injury consists of a fracture or dislocation of the radial head, rupture of the interosseous membrane (IOM), which is the main pathology, and a dislocated distal radio-ulnar joint. There are several reports in the literature, including cadaveric studies, which suggest an operative solution for this complicated injury. The torn IOM is not treated during the traditional operative repair. In the following paper, we suggest a treatment for the IOM by unloading it with the TightRope device. This device temporarily takes the tension off the torn IOM and assists in reduction and maintenance of the longitudinal ratios between the radius and the ulna, while allowing its healing. Recently, we have treated one patient with this system. The application of the TightRope technique in this acute injury and the follow-up are described in this case report.
BackgroundThe standard treatment to enhance fracture healing of scaphoid nonunions is surgery. Low-intensity pulsed ultrasound (LIPUS) is gaining in popularity as an alternative treatment to improve fracture healing; however, little is known about success rates of this treatment in scaphoid-delayed unions. The purpose of our study is to define the success rate of LIPUS treatment for delayed union of scaphoid fractures and further analyze whether initial management or fracture type influences success rate.MethodsDuring the period of 2011–2013, in the central orthopedic clinic of our institution, patients diagnosed with delayed union of the scaphoid were offered with LIPUS treatment as an alternative to conventional surgical treatment. These patients were then divided into subgroups according to the time elapsed from initial injury until diagnosis of the fracture.ResultsOverall, 22 of 29 (76 %) fractures healed, 12 of 13 (92 %) of the early diagnosed group, and 10 of 16 (63 %) of the late diagnosed group. Difference in healing rate between proximal pole, waist, and distal pole fractures was not statistically significant.ConclusionLIPUS can help heal delayed union scaphoid fractures, especially in fractures diagnosed and treated soon after injury and may serve as an alternative to surgical treatment.
Digit amputation is a physical and psychological trauma that can influence the daily living of a person. The rehabilitation of patients with digit amputation is a complex process and should take into consideration all influencing factors, such as the functional, emotional, social, and professional profile of the patient. This study was conducted to evaluate the functional level of patients with amputated fingers and to understand the factors that influence their rehabilitation. Fifty patients (42 male and 8 female with an age ranging from 7 to 84 years) who had digit amputation(s) between January of 1990 and December of 1998 at the level of the metacarpus or distal to it and who had at least 6 months of follow-up were examined. The patients were divided into three different study groups: patients with distal amputation were compared with patients who had proximal amputation, patients with one finger amputation were compared with patients who had multiple finger amputations, and patients who suffered finger amputations caused by work-related accidents were compared with those who suffered amputations caused by other incidents. In addition, the time lapse from the amputation was checked as an influencing factor for different functional levels. The results showed that patients with distal amputation reached a higher motor and sensory functional level than patients with proximal amputation. Patients with one-finger amputation reached higher motor, sensory, and activities of daily living functional levels than patients with multiple amputations, and the level of motor and sensory function of patients with finger amputations caused by work-related accidents was lower than that of patients who suffered amputations in other incidents. Time was proven to be an important factor in the process of motor and emotional recovery.
Nine anatomical parameters that may have a relation to the spinal canal size were directly measured in each of 594 cervical and lumbar vertebrae from young adult cadaver skeletons. The anteroposterior diameter of the spinal canal was the only parameter which could be statistically correlated with its cross-sectional area (P less than 0.05), and hence justifies the accepted practice of its use as an indicator of bony spinal canal size.
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