The outcomes of the treatment of major hand injuries achieved in our institution over the period of the one year were satisfactory, considering their severity and complexity. These results, in our mind, show clearly advantages coming from an existence of qualified service for hand injuries.
The objective of the study was a comparison of the outcomes of K-wire vs plate fixation for distal radial fractures used according to the proposed institutional algorithm. Fracture configurations A2, A3, B1, B2, C1 and some C2 were operated on with K-wire pinning, whereas B3 and some B2, C3 and some C2 were with locking palmar-plate fixation. Patients and Methods: Four hundred and sixty-seven patients were non-randomly allocated for either K-wire (n = 363) or palmarplate (n = 104) fixation. The results were assessed at 3 and 12 months by the same outcome measures. Results: At the 3-month assessment, statistically significant differences in grip strength and the DASH scores were noted in favour of the plate-fixation group. At the 12-month assessment, statistically significant differences were observed in the wrist palmar and dorsal flexion, favouring the plate-fixation group. Statistically significant differences were noted in radiological measures of the palmar tilt and the ulnar variance, both favouring the plate-fixation method. Meaningful secondary dislocations were noted in ten patients, all in the K-wire-fixation group. Conclusion: We conclude that palmar locking plate fixation in even more severe fractures leads to better radiological and clinical outcomes than K-wire fixation in less severe fractures.
Carpal tunnel release can be performed in local anaesthesia, peripheral nerves blocks (either proximally or distally), intravenous regional (Bier block) and general anaesthesia. To our knowledge, in Poland operations of carpal tunnel syndrome are routinely performed under brachial plexus block anaesthesia. The aim of the study was to compare the effectiveness of local versus brachial plexus block anaesthesia for carpal tunnel decompression. Material and methods. One hundred and fifty-five patients diagnosed with carpal tunnel syndrome were randomly allocated to the local anaesthesia or brachial plexus block. Operations were done with two minimally invasive techniques: one and two small incisions. Questionnaires received from 135 patients, 115 women (85%) and 20 men (15%) in a mean age of 57 years (range 31-87) were analyzed. Sixtysix patients (49%) received local infiltration with 2% Lignocaine, and 69 (51%) received brachial plexus block with a mixture of 2% Lignocaine and 0.5% Bupivacaine. Pre-intra-and post-operative patients' complaints were assessed in visual analogue scale, as well as duration of anaesthesia, operation and surgeon subjective satisfaction were noted. Results. Except tourniquet pain, there were no significant differences between the groups in the pain scores associated with disease or operation. Although tourniquet pain was significantly lower favoring brachial plexus block, but the difference was slight (VAS 1.9) and most the patients well tolerated shorttime inflation of the tourniquet. No significant difference was observed in duration of the operation, whereas duration of performing anaesthesia was significantly longer in brachial plexus blocks, but the difference of the mean values was as low as 1 minute. Operation under brachial plexus block provided greater surgeon's comfort. Conclusions. The results of this study show similar effectiveness of local and brachial plexus block anaesthesiae for carpal tunnel release, and confirm advantages of the former technique as simpler, cheaper and easier available. It seems that, according to European trends, local anaesthesia should be considered a method of choice in this operation and that fear associated with its use are not justified.
patients with dorsally displaced fractures of the distal radius were treated using a volar approach with the lcp. The mean age of the patients was 56 years (range 16-78 years). The average follow-up period was 15 months. The patients were assessed clinically at 6 weeks, 3 months, 6 months, 1 year and at the end of the study. Functional outcome was evaluated at the latest followup using the disabilities of the arm, shoulder and hand (dash) questionnaire and the gartland and werley scoring system. Radiographic assessment of the preoperative, postoperative and final follow-up radiographs was also performed. Results: Eighty-four per cent of patients had a good or excellent range of motion of the injured wrist and this resulted in an early return to former activity. There were a few cases of carpal tunnel syndrome and median nerve irritation. There were no cases of non-union or infection. Conclusion: Our preliminary results have shown that the volar locking compression plating technique is an effective means of treating dorsally displaced fractures of the distal radius.Objective: To compare the effectiveness of conservative and operative (K-wiring) treatment of displaced fractures of the distal radius with regard to objective and subjective parameters. Patients and methods: Over the period of 08 2004 to 04 2005 a total of 60 patients (47 women, 13 men, mean age of 56 years) with isolated, displaced distal radius fractures were identified. Thirty of them were randomized to conservative treatment with reduction and immobilization, the other 30 were randomized to close reduction and K-wire fixation. Patients were followed-up at 1.5, 3 and 6 months and objective (radiology: radial tilt, dorsal angulations, grip strength, wrist range of motion) and subjective parameters (pain, cold intolerance, DASH and Gertland-Werley scores) were assessed. Secondary displacement rate was calculated. Results: At 1.5 months, 30 patients treated operatively and 25 treated conservatively were available. Five patients in the conservative group were withdrawn because of secondary dislocation. Total grip strength, wrist ROM, DASH and Gertland-Werley scores were significantly better in the operated group. Other parameters did not differ significantly between the groups. At 3 months, 28 patients treated operatively and 23 treated conservatively were available. Total grip strength, wrist ROM, DASH and Gertland-Werley scores were significantly better in the operated group. Other parameters did not differ significantly between the groups. At 6 months, 22 patients treated operatively and 20 treated conservatively were available (the rest of the group is still at the follow-up). All the variables were better in the operative group, but differences were not statistically significant. Secondary displacement occurred in five patients treated conservatively and in one treated operatively (stat. sign.). Conclusion: K-wiring of displaced fractures of the distal radius is superior over the conservative treatment because it reduces displacement rate and provi...
Retroperitoneal abscesses present a relatively uncommon complication of diseases of various abdominal organs, although most commonly they are related to acute appendicitis of retrocoecal location. The paper presents the case of a healthy patient in whom an excessive left retroperitoneal abscess developed, perforated into the peritoneal cavity, and almost perforated through the skin in XII th intercostal space. The patient had no abdominal symptoms or signs, but complained from slight pain in the left lumbar area. The diagnosis was established based on abdominal computed tomography scanning and an operative treatment by laparotomy. The evacuation and drainage of the abscess was effective and the patient recovered. Bacteriological examination of the pus from the abdominal cavity revealed single colonies of anaerobic Fusobacterium species. The cause of the occurrence of the abscess remained unknown. Keywords: retroperitoneal abscess, unknown aetiology, Fusobacterium species. STRESZCZENIERopnie przestrzeni zaotrzewnowej to stosunkowo rzadko wystę-pujące powikłanie schorzeń różnych narządów jamy brzusznej, najczęściej ostrego zapalenia wyrostka robaczkowego, szczególnie położonego zakątniczo. W pracy przedstawiono przypadek dotychczas zdrowego pacjenta, u którego rozległy ropień powstał w lewej przestrzeni zaotrzewnowej, przebił się do jamy otrzewnowej i prawie przebił się przez skórę w XII przestrzeni międzyżebrowej. Pacjent nie miał objawów brzusznych, tylko skarżył się na umiarkowany ból w lewej okolicy lędźwiowej. Rozpoznanie ustalono na podstawie badania tomogra ii komputerowej jamy brzusznej, a leczenie operacyjne przez laparotomię, ewakuację i drenaż ropnia było skuteczne, gdyż pacjent wyzdrowiał. Badanie bakteriologiczne ropy z jamy brzusznej wykazało nieliczne kolonie bakterii beztlenowej Fusobacterium species. Przyczyna powstania ropnia pozostała nieustalona. Słowa kluczowe: ropień zaotrzewnowy, nieznana etiologia, Fusobacterium species. WSTĘPRopnie przestrzeni zaotrzewnowej stanowią stosunkowo rzadko występujące powikłanie schorzeń różnych narządów jamy brzusznej. W porównaniu do ropni wewnątrzotrzew-nowych, których przyczyną są zwykle zapalenia narządów wewnątrzbrzusznych lub powikłania pooperacyjne (nieszczelność zespoleń jelitowych, zakażone krwiaki), powody ropni zaotrzewnowych są znacznie bardziej urozmaicone. Mogą być powikłaniami perforacji przewodu pokarmowego do przestrzeni zaotrzewnowej: owrzodzenia trawiennego lub uchyłka dwunastnicy, zapalnia zmienionego wyrostka robaczkowego lub uchyłka okrężnicy, raka okrężnicy, ale także jatrogennej perforacji dwunastnicy w czasie s inkterotomii [ , , , ]. Inną przyczyną są zapalenia narządów położonych zaotrzewnowo -odmiedniczkowe zapalenie nerek i ostre zapalenie trzustki. Mogą być powikłaniem (zropieniem) pourazowych krwiaków zaotrzewnowych, często obserwowanych u pacjentów ze złamaniami kręgosłupa lędźwiowego i miednicy. Ropnie zaotrzewnowe mogą powstawać w przebiegu choroby Leśniowskiego-Crohna, ropnego zapalenia lub gruźlicy kręgosłupa lędźwiow...
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