Digital nerve injuries of the hand: epidemiological analysis, surgical treatment and possibility of spontaneous recovery

Povrede nerava spadaju među najraznovrsnija stanja u hrirurgiji, a ishod je frustrirajući kako za pacijenta, tako i za hirurga. Najčešće ove povrede pogađaju gornji ekstremitet i prouzrokuju značajne tegobe pacijentu, kako u radnim, tako i u svakodnevnim životnim aktivnostima. Najučestalije su povrede digitalnih nerava, a najčešće se javljaju kod mušakaraca u radno aktivnom dobu. Ove povrede mogu nastati usled jednostavnih posekotina ili mogu biti posledica teške traume šake. U slučajevima kada digitalni nervi ostanu neušiveni, aksonalni rast se rasipa i može nastati neurom koji će da ometa rehabilitaciju, funkcionalni oporavak šake, a uticaće i na hvat „štipaljke palac-kažiprst” i gnostičku funkciju celokupne šake. Senzibilitet je od esencijalne važnosti za normalno funkcionisanje ekstremiteta. Povrede digitalnih nerava su često udružene sa povredama susednih struktura (npr.tetiva). Testovi nervne sporovodljivosti su od male vrednosti kod svežih povreda šake, pa se tačna dijagnoza postavlja kombinacijom kliničkog pregleda i intraoperativnog nalaza. Ne postoji ni jedan univerzalni algoritam lečenja, a nažalost su rezultati nervne reparacije i danas ne bolji od „zadovoljavajući“, gde samo 50% pacijenta dostiže nivo opravka koji omogućava dobru funkciju. Postavljanjem korektne dijagnoze i započinjanjem odgovarajućeg lečenja, hirurg može da utiče na krajnji ishod. Od ključne važnosti je poznavanje strukture perifernih nerava i neurobioloških događaja koji prate povredu nerva. Novi rast aksona je delikatni proces dirigovan signalnim transdjuserskim mehanizmima. Ključni elementi neruoregeneracije su veličina defekta, Valerova degeneracija, specifičnost aksonskog vođenja i vitalnost terminalnih organa. Idealno, primarnu reparaciju nerva treba uraditi odmah, ili sa kratkim odlaganjem u dobro vaskularizovanom ležištu bez tenzije. U brojnim radovima su ispitivani prediktorni faktori senzitivnog oporavka. Mnogo faktora može uticati na krajnji ishod. Godine su bitan faktor, a deca pokazuju znatno bolji oporavak. Ovo je verovatno uslovljeno velikim kapacitetom njihove centralne adaptacije. Senzorno ponovno učenje, koje bazira na protokolima senzorne reedukacije, je stoga od krucijalne važnosti i neophodna klinička rutina za obnovu senzibiliteta. Princip uključuje vežbe, zatvorenih očiju, percepcije dodira i sposobnosti da se lokalizuje takav dodir i objasne njegove karakteristike, kao što su različiti oblici i teksture...A nerve injury is one of the most different conditions that a surgery treats and the outcome causes frustration for the patient and the surgeon. Most peripheral nerve injuries affect the upper extremity function and induce severe suffering for the patients, not only in their professional life but also impairing their everyday activities. The most common transection injury is a digital nerve injury, which mainly affect men in a productive age. Digital nerve injury can result from simple cuts or from severe hand trauma. In case a digital nerve is left unrepaired, the axonal growth will disperse and could lead to neuroma formation which then would interfere with rehabilitation, functional recovery, and involved in pinch and gnostic function. Sensibility is an essential factor, concerning a normal hand function. Transection injuries of peripheral nerves are often combined with injuries to adjacent structures (e.g. tendons). Nerve conduction testing has little value in the acute hand injury setting, and accurate diagnoses were made through a combination of the clinical examination and from the intraoperative evaluation. There is no single successful treatment algorithm and unfortunately, results of nerve repair to date have been no better than fair, with only 50% of patients regain satisfactory outcomes of useful function. By making a correct diagnosis and initiating appropriate treatment, the surgeon can influence the final results. It is crucial to understand the structure of a peripheral nerve and neurobiological events that occur after nerve injury. Outgrowth of axons after injury is a delicate process orchestrated by signal transduction mechanisms. Key elements of neuroregeneration are gap distance, Wallerian degeneration, axon guidance specifity, and end-organ viability. Ideally, primary nerve repair should be done immediately, or only slightly delayed in and environment with a well vascularised bed without tension. Predictors of sensory recovery have been evaluated in several studies. Many factors can influence functional recovery after nerve injury. Age is important reflected by a much better capacity in children. This is probably due to their potential for central adaptation. Sensory relearning, which is based on sensory reeducational protocols, is therefore of crucial importance and a necessary clinical routine to regain sensation..

Digital nerve injuries of the hand: epidemiological analysis, surgical treatment and possibility of spontaneous recovery

Povrede nerava spadaju među najraznovrsnija stanja u hrirurgiji, a ishod je frustrirajući kako za pacijenta, tako i za hirurga. Najčešće ove povrede pogađaju gornji ekstremitet i prouzrokuju značajne tegobe pacijentu, kako u radnim, tako i u svakodnevnim životnim aktivnostima. Najučestalije su povrede digitalnih nerava, a najčešće se javljaju kod mušakaraca u radno aktivnom dobu. Ove povrede mogu nastati usled jednostavnih posekotina ili mogu biti posledica teške traume šake. U slučajevima kada digitalni nervi ostanu neušiveni, aksonalni rast se rasipa i može nastati neurom koji će da ometa rehabilitaciju, funkcionalni oporavak šake, a uticaće i na hvat „štipaljke palac-kažiprst” i gnostičku funkciju celokupne šake. Senzibilitet je od esencijalne važnosti za normalno funkcionisanje ekstremiteta. Povrede digitalnih nerava su često udružene sa povredama susednih struktura (npr.tetiva). Testovi nervne sporovodljivosti su od male vrednosti kod svežih povreda šake, pa se tačna dijagnoza postavlja kombinacijom kliničkog pregleda i intraoperativnog nalaza. Ne postoji ni jedan univerzalni algoritam lečenja, a nažalost su rezultati nervne reparacije i danas ne bolji od „zadovoljavajući“, gde samo 50% pacijenta dostiže nivo opravka koji omogućava dobru funkciju. Postavljanjem korektne dijagnoze i započinjanjem odgovarajućeg lečenja, hirurg može da utiče na krajnji ishod. Od ključne važnosti je poznavanje strukture perifernih nerava i neurobioloških događaja koji prate povredu nerva. Novi rast aksona je delikatni proces dirigovan signalnim transdjuserskim mehanizmima. Ključni elementi neruoregeneracije su veličina defekta, Valerova degeneracija, specifičnost aksonskog vođenja i vitalnost terminalnih organa. Idealno, primarnu reparaciju nerva treba uraditi odmah, ili sa kratkim odlaganjem u dobro vaskularizovanom ležištu bez tenzije. U brojnim radovima su ispitivani prediktorni faktori senzitivnog oporavka. Mnogo faktora može uticati na krajnji ishod. Godine su bitan faktor, a deca pokazuju znatno bolji oporavak. Ovo je verovatno uslovljeno velikim kapacitetom njihove centralne adaptacije. Senzorno ponovno učenje, koje bazira na protokolima senzorne reedukacije, je stoga od krucijalne važnosti i neophodna klinička rutina za obnovu senzibiliteta. Princip uključuje vežbe, zatvorenih očiju, percepcije dodira i sposobnosti da se lokalizuje takav dodir i objasne njegove karakteristike, kao što su različiti oblici i teksture...A nerve injury is one of the most different conditions that a surgery treats and the outcome causes frustration for the patient and the surgeon. Most peripheral nerve injuries affect the upper extremity function and induce severe suffering for the patients, not only in their professional life but also impairing their everyday activities. The most common transection injury is a digital nerve injury, which mainly affect men in a productive age. Digital nerve injury can result from simple cuts or from severe hand trauma. In case a digital nerve is left unrepaired, the axonal growth will disperse and could lead to neuroma formation which then would interfere with rehabilitation, functional recovery, and involved in pinch and gnostic function. Sensibility is an essential factor, concerning a normal hand function. Transection injuries of peripheral nerves are often combined with injuries to adjacent structures (e.g. tendons). Nerve conduction testing has little value in the acute hand injury setting, and accurate diagnoses were made through a combination of the clinical examination and from the intraoperative evaluation. There is no single successful treatment algorithm and unfortunately, results of nerve repair to date have been no better than fair, with only 50% of patients regain satisfactory outcomes of useful function. By making a correct diagnosis and initiating appropriate treatment, the surgeon can influence the final results. It is crucial to understand the structure of a peripheral nerve and neurobiological events that occur after nerve injury. Outgrowth of axons after injury is a delicate process orchestrated by signal transduction mechanisms. Key elements of neuroregeneration are gap distance, Wallerian degeneration, axon guidance specifity, and end-organ viability. Ideally, primary nerve repair should be done immediately, or only slightly delayed in and environment with a well vascularised bed without tension. Predictors of sensory recovery have been evaluated in several studies. Many factors can influence functional recovery after nerve injury. Age is important reflected by a much better capacity in children. This is probably due to their potential for central adaptation. Sensory relearning, which is based on sensory reeducational protocols, is therefore of crucial importance and a necessary clinical routine to regain sensation..

Fractures of the humerus during arm wrestling

Background/Aim. Humeral shaft fractures may occur as a result of arm wrestling. The aim of this study was to present our treatment of humerus fracture sustained during arm wrestling. Methods. A total of six patients, aged 22 to 48, were treated at our department form January 2008 to January 2010 with open reduction and internal fixation and with hanging arm casts. A review of all the relevant literature on the subject was also presented. Results. In all the cases, the fractures healed and function returned to normal. No patient had any neural or vascular compromise. Conclusion. Closed and operative treatments were equally successful in all reported cases. [Projekat Ministarstva nauke Republike Srbije, br. 175-095

Unexpected life history traits in a very dense population of dice snakes

A population of dice snakes (Natrix tessellate) monitored since 2008 in a small island (18 ha, 850 m a.s.l., FYR of Macedonia) revealed unforeseen patterns for snakes living in temperate climates. More than 5000 individuals have been marked and the density is one of the highest ever recorded (>500 resident snakes per hectare). Reproductive and mortality rates are elevated, suggesting a high population turnover. These traits evoke a tropical rather than a temperate-climate ophidian demographic system. The population is highly polymorphic, three colour morphs (dotted, grey, and black) are observed in both sexes and each morph is represented by large numbers of individuals. This polymorphism pattern was not previously documented in snakes. Data obtained for other life history traits (e.g. body size, size at maturity, clutch size, diet, predation) markedly diverged in comparison to available information. Overall, our results reinforce the notion that the strong inter-population variability (often mediated by phenotypic plasticity) of snakes should be taken into account over large geographic scales; otherwise attempts to derive general patterns may well be strongly biased. (C) 2012 Elsevier GmbH. All rights reserved.Ministry of Education and Science of Republic of Serbia [173043, 173025]; Republic of France; Republic of Serbia; French Embassy; French Cultural Centre in Belgrad