One hundred eighty seven patients with dislocation and dislocation-fracture of carpal bones were treated. There were 81 patients with acute injuries and 106 patients with old ones. In 33.6% of cases injuries of carpal bones were combined with fractures of other bones forming wrist joint. In 20.3% of cases neurologic deficit was detected. Clinical manifestations, diagnosis and peculiarities of treatment were presented. Authors considered the conduction anesthesia to be the best analgetic method. In acute trauma close manual reduction was indicated. Indications for operative treatment were non-reduced dislocations and dislocation-fractures as well as impossibility of reduction of scapoid bone. In case of wrist joint instability temporary Stabilization of wrist joint by К-wires should be performed. In old injuries two-step treatment was recommended: 1st step - distraction of the wrist joint; 2nd step - open reduction of dislocation and dislocation-fracture and osteosynthesis of the scapoid bone. Good and satisfactory results were achieved in 91% of cases.
Department of Traumatology, Orthopedics and Surgery of Extreme Conditions, Russian State Medical University, MoscowThe work is based on the experience of treating 382 patients with extensive open injuries and 95 patients with destruction of the hand. The main importance is attached to the timely and high-quality primary surgical treatment of the wound and the correct choice of surgical treatment tactics (primary or delayed performance of restorative operations). The use of low-traumatic methods of osteosynthesis during the primary surgical treatment of the wound in case of hand injuries accompanied by impaired blood flow in the main type helps to reduce the frequency of necrotic complications. Long-term results of treatment are known in 357 patients. 40% of them are disabled of the III group, which is due to the severity of the injuries. Of 357 patients, 318 (89%) returned to work
Experience in surgical treatment of 112 patients with malunited fractures of distal radius epimetaphysis is presented. Indication to surgical intervention was fragments consolidation with displacement that was accompanied by marked wrist joint deformity and hand function disturbance. In all patients osteotomy and bone plasty were performed followed by application of distraction device. In the postoperative period dosed distraction of bone fragments up to their complete reposition and rehabilitation treatment was performed. Long term results were assessed for all 87 patients: good result was achieved in 67 (77%), satisfactory - in 17 (19.5%) and poor - in 3 (3.5%) patients.
Examination and treatment results of 27 patients with lateral instability of metacarpal-phalanx thumb joint were presented. The indication to operation and technique of surgical intervention in dependence on the terms from injury moment, presence or absence of instability, value of passive lateral deviation angle were detected. Surgical technique for the treatment of complete tears of collateral ligaments of metacarpal-phalanx thumb joint was perfected. In 22 patients follow up period ranged from 6 to 12 months. Excellent results were achieved in 13 (59%), good - in 7(32%), satisfactory - in 2 (9%) patients.
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