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- Forward, Daren P., et al.
(författare)
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Intercarpal ligament injuries associated with fractures of the distal part of the radius
- 2007
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 89A:11, s. 2334-2340
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Tidskriftsartikel (refereegranskat)abstract
- Background: Soft-tissue injuries of the wrist are often not recognized in patients with distal radial fractures, yet scapholunate injuries have been reported to occur in association with as many as 54% of distal radial fractures. The true prevalence and natural history of intercarpal ligament injury are not known. Methods: This prospective observational study assessed the prevalence and one-year outcome of intercarpal ligament injuries in non-osteoporotic patients with displaced fractures of the distal part of the radius. The study group consisted of fifty-one patients (twenty-seven women and twenty-four men) with a median age of forty-one years (range, twenty to fifty-seven years). Patients underwent standard fracture treatment and, in addition, wrist arthroscopy was performed to identify associated carpal injuries. No ligamentous injuries were treated. Patients were reviewed at one year and underwent physical and radiographic evaluation. Patients were analyzed according to the status of the scapholunate ligament at the time of the injury and were graded with use of a modification of the Geissler classification system: Group I consisted of ten patients with a grade-3 scapholunate ligament injury, and Group II consisted of forty-one patients with a grade-0, 1, or 2 injury. Results: Patients with an increase in ulnar variance of >2 mm at the time of the injury had a fourfold increase in the risk of sustaining a grade-3 scapholunate ligament injury (p = 0.01). Radiographically, at one year, patients in Group I (grade-3 injuries) had a greater amount of static and dynamic scapholunate dissociation and a significantly greater increase in the scapholunate angle in comparison with the uninjured wrist (p = 0.006) than did those in Group II. Intra-articular fractures were associated with a twofold increase in the prevalence of scapholunate dissociation as seen radiographically at one year. The prevalence of subjective pain on examination was significantly greater in Group I than in Group II (p = 0.009). There were no significant differences between the two groups with respect to objective outcome according to range of motion and hand grip and tip pinch strengths. Lunotriquetral injuries were uncommon and did not correlate with the scapholunate injuries, fracture grade, or configuration. Conclusions: Grade-3 scapholunate ligament tears can be associated with ulnar positive variance at the time of initial presentation of a distal radial fracture and can be associated with more scapholunate joint pain at one year. These injuries could lead to scapholunate dissociation at the time of follow-up, particularly in patients with intra-articular fractures.
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| 2. |
- Lindau, Tommy R, et al.
(författare)
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Fractures of the distal forearm in young adults. An epidemiologic description of 341 patients
- 1999
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Ingår i: Acta Orthopaedica Scandinavica. - : Medical Journals Sweden AB. - 0001-6470. ; 70:2, s. 124-128
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Tidskriftsartikel (refereegranskat)abstract
- We describe the epidemiology of all distal radial fractures in young adults (men 20-59 years, women 20-49 years) in Lund (1992-95) and Malmo (1994-95), Sweden. During the study period, there were 341 patients with 346 fractures in the two cities, found through the Hospital Register of Diagnoses in Lund and the register of the Radiology Department in Malmo. More than half of the fractures were dislocated and 2/3 of the cases involved the radiocarpal or radioulnar joints, in contrast to the predominantly extra-articular fractures in the elderly. There was an even distribution between sexes and the fractures were mainly caused by a severe trauma, i.e., more than a simple fall, most often sports injuries in January, February and May. Our findings suggest that distal radial fractures in nonosteoporotic young adults should be regarded as a special entity, at least in epidemiological studies. Possibly they also require treatment differing from that for osteoporotic fractures.
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| 3. |
- Witthaut, Jörg, et al.
(författare)
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Efficacy and Safety of Collagenase Clostridium Histolyticum Injection for Dupuytren Contracture : Short-Term Results From 2 Open-Label Studies
- 2013
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Ingår i: Journal of Hand Surgery-American Volume. - : Elsevier BV. - 0363-5023 .- 1531-6564. ; 38A:1, s. 2-11
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The JOINT I (United States) and JOINT II (Australia and Europe) studies evaluated the efficacy and safety of collagenase clostridium histolyticum (CCH) injection for the treatment of Dupuytren contracture. Methods Both studies used identical open-label protocols. Patients with fixed-flexion contractures of metacarpophalangeal (MCP) (20 degrees to 100 degrees) or proximal inteiphalangeal (PIP) joints (20 degrees to 80 degrees) could receive up to three 0.58-mg CCH injections per cord (up to 5 total injections per patient). We perfonned standardized finger extension procedures to disrupt injected cords the next day, with follow-up 1, 2, 6, and 9 months thereafter. The primary end point (clinical success) was reduction in contracture to within 0 degrees to 5 degrees of full extension 30 days after the last injection. Clinical improvement was defined as 50% or more reduction from baseline contracture. Results Dupuytren cords affecting 879 joints (531 MCP and 348 PIP) in 587 patients were administered CCH injections at 14 U.S. and 20 Australian/European sites, with similar outcomes in both studies. Clinical success was achieved in 497 (57%) of treated joints using 1.2 +/- 0.5 (mean +/- SD) CCH injections per cord. More MCP than PIP joints achieved clinical success (70% and 37%, respectively) or clinical improvement (89% and 58%, respectively). Less severely contracted joints responded better than those more severely contracted. Mean change in contracture was 55 degrees for MCP joints and 25 degrees for PIP joints. With average contracture reductions of 73% and improvements in range of motion by 30 degrees, most patients (92%) were "very satisfied" (71%) or "quite satisfied" (21%) with treatment. Physicians rated change from baseline as "very much improved" (47%) or "much improved" (35%). The CCH injections were well tolerated, causing no tendon ruptures or systemic reactions. Conclusions Collagenase clostridium histolyticum was an effective, minimally invasive option for the treatment of Dupuytren contracture of a broad range of severities. Most treated joints (625 of 879) required a single injection. Treatment earlier in the course of disease provided improved outcomes.
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