Laivelio lūžio rekonstrukcija šonkaulio autotransplantatu: klinikinis atvejis ir literatūros apžvalga

Objective. To evaluate the results of scaphoid bone proximal pole reconstruction with rib osteochondral autograft due to comminuted scaphoid fracture. Material and methods. We present a clinical case of fragmented scaphoid bone proximal pole fracture reconstruction by rib osteochondral autograft. The modified wrist function score of Green and O’Brien and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) outcome measuring scales were used for clinical evaluation before and 6 months after the reconstruction. Additio­nally, a literature review was conducted for case reports and previous literature reviews describing scaphoid bone proximal pole fracture surgical treatment. Medline (PubMed), ScienceDirect and UpToDate databases were used. Results. Conventional treatment methods for the treatment of comminuted proximal pole scaphoid bone fractures are often inappropriate due to technical issues or potential adverse outcomes. In these cases, reconstruction with rib autograft is possible. The study patient’s modified wrist function score of Green and O’Brien increased from 75 to 95 points out of 100 at 6 months postoperatively, and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score decreased from 13.64 to 4.55 points. The results of this technique have been investigated in several studies (Sandow, 1998, 2001; Veitch et al., 2007). All subjects (22, 47 and 14 patients, respectively), except one, experienced improvement of wrist function – enhanced wrist movement, grip strength, reduced pain and restored wrist function to the pre-injury performance level. Conclusions. Scaphoid bone proximal pole fragmented fracture reconstruction with osteochondrial rib autograft achieves favorable recovery of wrist function and avoids complications or unfavorable functional consequences of alternative surgical procedures.Tikslas. Įvertinti laivelio proksimalinio poliaus rekonstrukcijos šonkaulio osteochondriniu autotransplantatu rezultatus, gydant skeveldrinį lūžį. Tyrimo metodai. Pateikiamas laivelio proksimalinio poliaus skeveldrinio lūžio rekonstrukcijos šonkaulio osteochondriniu autotransplantatu klinikinis atvejis. Klinikiniam paciento įvertinimui prieš operaciją ir praėjus 6 mėn. po atliktos rekonstrukcijos pasitelktas modifikuotas Greeno ir O’Brieno riešo funkcijos balas ir Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) vertinimo skalė. Taip pat, naudojantis Medline (PubMed), ScienceDirect ir UpToDate duomenų bazėmis, atlikta mokslinės literatūros apžvalga, apimanti laivelio proksimalinio poliaus lūžių chirurginio gydymo metodus ir galimybes. Rezultatai. Esant laivelio proksimalinio poliaus lūžiams, ypač skeveldrinio pobūdžio, tradiciniai gydymo metodai dėl techninių atlikimo principų ar numatomų nepalankių išeičių dažnai yra netinkami. Minėtais atvejais galima rekonstrukcija šonkaulio osteochondriniu autotransplantatu. Tirtam pacientui nustatytas modifikuotas Greeno ir O’Brieno riešo funkcijos balas, praėjus 6 mėn. po rekonstrukcinės operacijos, padidėjo nuo 75 iki 95 balų iš 100, o taikant Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) apskaičiuotas balas sumažėjo nuo 13,64 iki 4,55 balų. Minimų metodikų išeitys atskleidžiamos ir keliuose užsienio tyrimuose (Sandow, 1998, 2001; Veitch et al., 2007). Šių tyrimų duomenimis, atlikus laivelio rekonstrukciją osteochondriniu šonkaulio autotransplantatu, visų tiriamųjų (atitinkamai 22, 47 ir 14 pacientų), išskyrus vieną pacientą, judesio amplitudė ir sugriebimo jėga padidėjo, sumažėjo skausmas, tiriamieji atgavo prieš traumą buvusį darbingumą. Išvados. Atliekant laivelio proksimalinio poliaus skeveldrinio lūžio rekonstrukciją, kai kaulinio audinio defektas atkuriamas osteochondriniu šonkaulio autotransplantatu, pasiekiama palankių riešo funkcijos atkūrimo rezultatų, išvengiama alternatyvioms chirurginėms procedūroms būdingų komplikacijų ar nepalankių funkcinių padarinių

Stenozuojančio tenosinovito operacinis gydymas: ankstyvieji ir vėlyvieji rezultatai, komplikacijos

Background. The thickening of A1 pulley of the tendon sheath limits the excursion of flexor tendon. Stenosing tenosynovitis causes finger movements dysfunction and pain. Objective. To analyze early and late outcomes of patients with stenosing tenosynovitis after surgical treatment – anulotomy. Methods. All patients had standard surgical procedure – open anulotomy of A1 pulley. Pain (verbal pain scale), hand and arm function (QuickDASH) and complications were recorded before surgery, after 1 week, 3 months and 6 months post surgery. Results. There were 45 patients, 29 (64%) female, 16 (36%) male. The highest pain score was recorded before surgery median 5 (IQR 5). The lowest pain score median 2 (IQR 2) was recorded after 6 months post surgery. The difference of the results after 1 week, 3 months and 6 months was statistically significant p < 0.001. The worst hand and arm function was before surgery and 1 week post surgery. Accordingly: medians 52 (IQR 33) and 52 (IQR 35). Full hand function recovery was noticed after 6 months post surgery median 0 (IQR 11). The difference is statistically significant p < 0.001. Conclusions. Surgical treatment, open anulotomy is one of the most effective methods for stenosing tenosynovitis. After this procedure pain and hand function improves greatly. However, for some patients it might cause discomfort of the hand because of the scar’s sensitivity and location.Įvadas. Sustorėjęs A1 skaidulinis žiedas, esantis ties delnakaulio galva, neleidžia sausgyslei laisvai judėti kanale. Pasireiškus šiam sutrikimui, pacientai, lenkdami ar tiesdami pirštą, jaučia vietinį skausmą ir strigimą. Tikslas. Įvertinti pacientų, sergančių stenozuojančiu tenosinovitu, ankstyvuosius ir vėlyvuosius rezultatus, pritaikius atvirąjį chirurginį gydymą, atliekant anulotomiją. Metodika. Tiriamiesiems atlikta standartinė operacija – atviras chirurginis plaštakos piršto skaidulinio A1 žiedo atvėrimas (anulotomija). Skausmas (verbalinė skausmo skalė), plaštakos ir rankos funkcijos (QuickDASH) bei komplikacijos vertinta po operacijos praėjus 1 sav., 3 mėn. ir 6 mėn. Rezultatai. Tyrime dalyvavo 45 pacientai, iš jų – 29 (64 %) moterys, 16 (36 %) vyrų. Didžiausią skausmą pacientai jautė prieš operaciją (mediana – 5; TKN 5), mažiausią – praėjus 6 mėn. po operacijos (mediana – 2; TKN 2). Skausmo rezultatų skirtumas prieš operaciją ir praėjus 1 sav., 3 mėn. bei 6 mėn. po operacijos – statistiškai reikšmingas (p < 0,001). Rankos ir plaštakos funkcijos blogiausiai vertintos prieš operaciją ir praėjus 1 sav. po operacijos (mediana atitinkamai: 52 (TKN 33) ir 52 (TKN 35). Plaštakos funkcija pacientams atkurta praėjus 6 mėn. po operacijos (mediana – 0; TKN 11). Skirtumas statistiškai reikšmingas (p < 0,001). Išvados. Atviroji anulotomija – viena iš efektyviausių stenozuojančio tenosinovito gydymo metodikų. Atlikus šią operaciją, gerėja plaštakos funkcija, mažėja skausmas. Vis dėlto pooperaciniu laikotarpiu nemažai daliai pacientų kyla tam tikrų nepatogumų ar komplikacijų, iš kurių dažniausiai minėtinas nepatogus randas. Neretai pacientus vargina rando jautrumas

Riešo kanalo tunelinio sindromo diagnostinių metodų palyginimas

Background. Carpal tunnel syndrome is the most common and widespread peripheral neuropathy in the world. The diagnostic testing methods for the carpal tunnel syndrome are based on anamnesis data, objective and instrumental inspection. Electroneuromyography is the main instrumental test when carpal tunnel syndrome is suspected. An ultrasound imaging may also be performed. Objective. To determine the effectiveness, sensitivity and specificity of instrumental diagnostics methods used to diagnose the carpal tunnel syndrome, and to compare them. Methods. Diagnostic testing – ultrasound and electroneuromyography was applied to persons under study. The area of the median nerve (mm2) was assessed during the ultrasound examination. The results of the electroneuromyography study evaluated the response speed of the sensory impulse (ms), the speed of the motor impulse response (ms). Later, the tests, their sensitivity and specificity were evaluated and compared. Results. 30 patients participated in the study, of which 26 (86.7%) were women, 4 (13.3%) were men. Electroneuromyography was found to be both sensitive and specific for a measure of sensory propagation velocity, 76.2 and 75%, respectively (p = 0.042); of motor propagation speed – 100 and 75% (p = 0.040). Ultrasonography is sensitive (87.5%) but nonspecific (66.7%) (p = 0.008). The study showed that the ultrasound dimension strongly, directly and reliably correlates with the sensory impulse response rate (p < 0.001), and the ultrasound dimension moderately, directly and reliably correlates with the motor impulse response rate (p < 0.001). Conclusions. Carpal tunnel syndrome can be suspected by ultrasound measurement of the area of the median nerve, but the test is only sensitive but non-specific. Electroneuromyography can confirm the diagnosis of carpal tunnel syndrome, as the test is both sensitive and specific. Comparing the studies, a strong, direct and reliable relationship between the results of the ultrasound and the electroneuromyography testing was established.vadas. Riešo kanalo sindromas – labiausiai paplitusi periferinių nervų neuropatija pasaulyje. Riešo kanalo tunelinio sindromo diagnostika paremta anamnezės duomenimis, objektyviu ištyrimu ir instrumentiniais tyrimo metodais. Pagrindinis instrumentinis tyrimas, įtariant riešo kanalo sindromą, yra elektroneuromiografija. Taip pat gali būti atliekamas ultragarsinis tyrimas. Tikslas – įvertinti pacientams, sergantiems riešo kanalo sindromu, taikytų instrumentinių diagnostinių metodų efektyvumą, jautrumą bei specifiškumą ir palyginti šiuos metodus tarpusavyje. Metodika. Tiriamiesiems atlikti diagnostiniai – ultragarsinis ir elektroneuromiografijos – tyrimai. Ultragarsinio tyrimo metu vertintas vidurinio nervo plotas (mm2). Elektroneuromiografijos tyrimu vertintas sensorinio impulso atsako greitis (ms) ir motorinio impulso atsako greitis (ms). Vėliau abu diagnostiniai tyrimai įvertinti atskirai, išskirtas jų jautrumas ir specifiškumas, metodai palyginti tarpusavyje. Rezultatai. Tyrime dalyvavo 30 pacientų, iš jų – 26 (86,7 %) moterys, 4 (13,3 %) vyrai. Nustatyta, kad elektroneuromiografijos tyrimas yra ir jautrus, ir specifiškas: sensorinio impulso atsako sklidimo greičio matmuo atitinkamai 76,2 % ir 75 % (p = 0,042); motorinio impulso atsako sklidimo greičio matmuo – 100 % ir 75 % (p = 0,040). Ultragarsinis tyrimas yra jautrus (87,5 %), tačiau nespecifiškas (66,7 %) (p = 0,008). Tyrimas parodė, kad ultragarsinis matmuo stipriai, tiesiogiai ir patikimai koreliuoja su sensoriniu impulso atsako greičiu (p < 0,001). Taip pat ultragarsinis matmuo vidutiniškai, tiesiogiai ir patikimai koreliuoja su motoriniu impulso atsako greičiu (p < 0,001). Išvados. Ultragarsu matuojant vidurinio nervo plotą, pacientui galima įtarti riešo kanalo sindromą, tačiau tyrimas yra tik jautrus, bet nespecifiškas. Atlikus elektroneuromiografijos tyrimą, riešo kanalo sindromo diagnozę galima patvirtinti, nes tyrimas yra ir jautrus, ir specifiškas. Tyrimus lyginant tarpusavyje, tarp ultragarsinio tyrimo ir elektroneuromiografijos tyrimo rezultatų nustatytas stiprus, tiesioginis ir patikimas ryšys

Alkūnės kanalo sindromo chirurginio gydymo rezultatai

Background. Cubital tunnel syndrome is the second most commonly diagnosed compressive neuropathy of the upper extremity after carpal tunnel syndrome and the most common neuropathy of the ulnar nerve. Objective. To evaluate the results of surgical treatment of patients with cubital tunnel syndrome by performing an open decompression in situ. Methods. All subjects underwent a standard operation – open surgical opening of the elbow canal (decompression in situ). On the day of surgery, after 3 months, after 6 months, pain (verbal pain scale), hand and arm function (QuickDASH), complications are evaluated. Results. There were 44 patients, 16 (36%) female, 28 (64%) male. In 50% of the patients, electroneuromyography revealed a severe degree of ulnar nerve damage, in the rest – a moderate degree of damage. Hand function for women 3 months after surgery improved by 42.046 points (according to QuickDASH), while in men it was 15.454 points (p < 0.05). Meanwhile, hand function for woman 3 months after surgery improved by 45.833 points, while in men it was 20.000 points (p < 0.05). Statistically significant differences between the groups with a moderate and severe degree of damage were found only when assessing pain according to the VAS scale at 3 months after surgery (mean VAS scores 1.2 and 2.8 respectively). A positive correlation was also observed between age and improvement in hand function between 3–6 months after surgery (p < 0.05). In older people, improvement in hand function is observed after a longer period of time after surgery, and a more pronounced improvement in hand function with a severe degree of damage (comparing function before surgery and 6 months after surgery) is experienced by younger people. Conclusions. In situ decompression of the ulnar nerve is one of the most effective methods of treating ulnar neuropathy. With this method an improvement in the function of the hand and a decrease in pain are observed.Įvadas. Alkūnės kanalo tunelinis sindromas – antra po riešo kanalo sindromo dažniausiai diagnozuojama kompresinė viršutinės galūnės neuropatija ir dažniausiai nustatomas alkūninio nervo neurologinis sutrikimas. Tikslas – įvertinti pacientų, operuotų dėl alkūnės kanalo sindromo, chirurginio gydymo rezultatus, atliekant atvirąją dekompresiją. Metodika. Tiriamiesiems atlikta standartinė operacija – atvirasis chirurginis alkūnės kanalo atvėrimas (dekompresija in situ). Operacijos dieną ir po operacijos praėjus 3 mėn. ir 6 mėn. vertintas skausmas (verbalinė skausmo skalė), plaštakos ir rankos funkcija (QuickDASH), komplikacijos. Rezultatai. Klinikiniame tyrime dalyvavo 44 pacientai, iš jų – 28 (64 %) vyrai ir 16 (36 %) moterų. 50 proc. pacientų elektroneuromiografijos tyrimu nustatytas sunkaus laipsnio alkūninio nervo pažeidimas, likusiems – vidutinio laipsnio pažeidimas. Praėjus 3 mėn. po operacijos, moterims plaštakos funkcija pagerėjo vidutiniškai 42,046 balo (QuickDASH), vyrams – 15,454 balo (p < 0,05). Praėjus 6 mėn. po operacijos, rankos funkcija, palyginti su rezultatu prieš operaciją, moterims pagerėjo vidutiniškai 45,833 balo, vyrams – 20,000 balo (p < 0,05). Statistiškai reikšmingas skirtumas tarp vidutinio ir sunkaus laipsnio pažeidimų grupių nustatytas tik vertinant skausmą, remiantis VAS skale, praėjus 3 mėn. po operacijos (VAS balų vidurkiai – atitinkamai 1,2 ir 2,8). Praėjus 3–6 mėn. po operacijos, rankos funkcijos pagerėjimas teigiamai koreliavo su tiriamųjų amžiumi (p < 0,05). Vyresniems pacientams rankos funkcijos pagerėjimas nustatytas praėjus daugiau laiko po operacijos. Didesnį rankos funkcijos pagerėjimą (lyginant funkciją prieš operaciją ir praėjus 6 mėn. po operacijos), esant sunkiam pažeidimo laipsniui, patiria jaunesni asmenys. Išvados. In situ alkūninio nervo dekompresija – viena iš efektyviausių alkūninio nervo neuropatijos gydymo metodikų. Taikant šį chirurginio gydymo metodą, pagerėja plaštakos funkcija, sumažėja skausmas

Associations Between the Fracture Type and Functional Outcomes After Distal Radial Fractures Treated With a Volar Locking Plate

Objective. The aim of this study to investigate the associations of fracture type, age, and gender with hand function after distal radius fractures treated with a volar locking plate at a 6-month follow-up. Material and Methods. A total of 120 patients with displaced distal radius fractures were included into the study. They were operated on using a volar locking plate system. All the fractures were classified according to the AO classification, and the patients were divided into 3 groups by the fracture type. The range of motion and grip strength were evaluated at the 6-month follow-up. Multivariate linear regression analysis was used to evaluate the associations of age, gender, and fracture type with the score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The DASH questionnaire was completed as an outcome measure. Results. A total of 28 patients experienced type A fractures; 70 patients, type B fractures; and 22 patients, type C fractures. No statistically significant difference regarding age and sex among the groups was observed. At 6 months after the surgery, the mean DASH score for type A, B, and C fractures was 16, 13, and 32, respectively (P=0.01). After the surgery, the radiographic parameters such as the volar tilt and the ulnar variance were significantly worse in the patients with type C fractures. Grip strength and the range of motion of the contralateral healthy hand at the 6-month follow-up were significantly better than those of the operated hand. The linear regression analysis showed that the type C fracture was the only factor significantly associated with lower DASH score. Conclusions. The patients with type C fractures treated with a volar locking plate had a worse wrist function as compared with the patients type A and B fractures at the 6-month follow-up. The postoperative hand function was significantly associated only with the type C fracture, while age and gender had no significant impact

Dupuytren’s contracture: incidence of injury-induced cases and specific clinical expression

Background and objectives: Dupuytren’s contracture is a chronic fibroproliferative hand disorder with a varying pattern of genetic predisposition across different regions and populations. Traumatic events have been found to have influence on the development of this illness and are likely to trigger different clinical forms of this disease. The aim of this study was to evaluate the phenomenon of development of Dupuytren’s contracture (DC) following an acute injury to the hand, and to observe the incidence and clinical diversity of such cases in daily clinical practice. Materials and Methods: We collected data of patients presenting with primary Dupuytren’s contracture in the Lithuanian population and evaluated the occurrence and clinical manifestation of this specific type of DC, arising following acute hand trauma. The diagnosis of DC was based on clinical signs and physical examination. Digit contractures were measured by goniometry, and the staging was done according to Tubiana classification. Injury-induced (injury-related) cases were identified using the “Criteria for recognition of Dupuytren’s contracture after acute injury” (established by Elliot and Ragoowansi). Results: 29 (22%) of a total of 132 cases were injury-induced DCs. Twenty-six of 29 patients in this group presented with stage I–II contractures. Duration of symptoms was 6 (SD 2.2) and 3.8 (SD 2.2) years in the injury-related and injury-unrelated DC groups, respectively. Mean age on the onset of symptoms in the injury-induced and non-injuryinduced groups was 52 (SD 10.7) and 56 (SD 10.9), respectively. Patients from both groups expressed strong predisposition towards development of DC. Conclusions: Around one-fifth of patients seeking treatment for primary Dupuytren’s contracture seemed to suffer from injury-induced Dupuytren’s contracture. [...]

Assessment of Standard Surgical Excision Efficacy and Analysis of Recurrence-Associated Factors in 343 Cases of Nasal Basal Cell Carcinoma: A Single-Center Retrospective Study

In Caucasians, basal cell carcinoma, the predominant non-melanoma skin cancer type, poses challenges for surgeons due to anatomical and aesthetic concerns, particularly when located on the nose. The study aimed to evaluate tumor distribution, size, morphological subtypes, surgical outcomes, radicality levels, and their correlation with recurrence rates. A retrospective analysis encompassed 343 cases of nasal skin cancer over a four-year period from 1 January 2019 to 31 December 2022. The research cohort comprised 252 female and 91 male participants, averaging 75.2 years old. Tumors were most found on the left sidewall of the nose (25.4%) and the dorsum (24.8%). The infiltrative morphological subtype was predominant (70.8%). Standard surgical excision with fasciocutaneous plastic was the preferred surgical procedure. Radical excision, defined by the absence of tumor cells in a resection margin, was accomplished in 79.0% of lesions, whereas 16.9% demonstrated incomplete excision, signifying the presence of tumor cells in the resection margin. Non-radically excised tumors exhibited a significantly higher recurrence rate (24.1%) compared to those with radical excision (6.3%). In nasal reconstruction, diverse surgical techniques are essential for precise adaptation based on factors like tumor characteristics and patient needs. Despite surgeons’ careful adherence to excision margin guidelines, the possibility of non-radical outcome cannot be eliminated