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Hodea FV, Grosu-Bularda A, Teodoreanu RN, Cretu A, Ratoiu VA, Lascar I, Hariga CS. Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections-A Five-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:895. [PMID: 38929511 PMCID: PMC11205443 DOI: 10.3390/medicina60060895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.
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Affiliation(s)
- Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Razvan Nicolae Teodoreanu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andrei Cretu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Vladut-Alin Ratoiu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
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Krasny C, Radda C, Polke R, Schallmayer D, Borchert GH, Albrecht C. A human, allogeneic cortical bone screw for distal interphalangeal joint (DIP) arthrodesis: a retrospective cohort study with at least 10 months follow-up. Arch Orthop Trauma Surg 2023; 143:4557-4564. [PMID: 36757467 PMCID: PMC10293363 DOI: 10.1007/s00402-023-04785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/21/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION The prime requisites of a good digital arthrodesis are a painless and stable union in a proper position. Arthrodesis of the distal interphalangeal joint of the fingers is not without potential complications including nonunion, malunion, and deep tissue infections. The Shark Screw® is a human, cortical bone allograft for osteosynthesis and an alternative to metal or bioabsorbable devices in orthopedics and trauma surgery. The primary hypothesis is that the fusion and complication rate, using the Shark Screw®, is at least similar to those reported in the literature, using metal or bioabsorbable screws. MATERIAL AND METHODS This retrospective cohort study analyzes the fusion and complication rate and the patient satisfaction of distal interphalangeal joint arthrodesis of 27 fingers with the human allogeneic cortical bone screw. Complications, Disabilities of Arm, Shoulder, and Hand Questionnaire (Quick-DASH) score and Michigan Hand Outcomes Questionnaire (MHQ) score, grip and pinch strength and fusion angle were investigated. RESULTS The mean follow-up was 23 months. At 6 weeks after surgery, fusion was obtained for all fingers. There was no surgical complication that required revision surgery. An average fusion angle of 13.6° ± 10.7° was measured. VAS pain score decreased significantly from 6.9 before surgery to 0.14 after surgery. The Quick-DASH score decreased from 10.7 to 7.8. The MHQ score improved in all sub-scores. CONCLUSION The complication rates, using the Shark Screw® for DIP joint arthrodesis, are lower compared to the results reported in the literature for other surgical techniques. Complications related to the human allograft cortical bone screw itself were not observed. The bone screw is completely remodeled into the host bone and further hardware removal is not necessary. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Christian Krasny
- Orthopaedic Hospital Vienna-Speising, 1st Departement, Speisinger Straße 109, 1130 Vienna, Austria
| | - Christian Radda
- Orthopaedic Hospital Vienna-Speising, 1st Departement, Speisinger Straße 109, 1130 Vienna, Austria
| | - Ralf Polke
- Orthopaedic Hospital Vienna-Speising, 1st Departement, Speisinger Straße 109, 1130 Vienna, Austria
| | - Daniel Schallmayer
- Orthopaedic Hospital Vienna-Speising, 1st Departement, Speisinger Straße 109, 1130 Vienna, Austria
| | - Gudrun H. Borchert
- Dr. Borchert Medical Information Management, Egelsbacher Str. 39E, 63225 Langen, Germany
| | - Christian Albrecht
- Orthopaedic Hospital Vienna-Speising, 1st Departement, Speisinger Straße 109, 1130 Vienna, Austria
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Zhu SL, Chin B, Sarraj M, Wang E, Dunn EE, McRae MC. Denervation as a Treatment for Arthritis of the Hands: A Systematic Review of the Current Literature. Hand (N Y) 2023; 18:183-191. [PMID: 33648375 PMCID: PMC10035088 DOI: 10.1177/1558944721994251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Joint denervation has been proposed as a less invasive option for surgical management of hand arthritis that preserves joint anatomy while treating pain and decreasing postoperative recovery times. The purpose of this systematic review was to investigate the efficacy and safety of surgical joint denervation for osteoarthritis in the joints of the hand. EMBASE, MEDLINE, and PubMed databases were searched from January 2000 to March 2019. Studies of adult patients with rheumatoid arthritis or osteoarthritis of the hand who underwent joint denervation surgery were included. Two reviewers performed the screening process, data abstraction, and risk of bias assessment (Methodological Index for Non-Randomized Studies). This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (#125811). Ten studies were included, 9 case series and 1 cohort study, with a total of 192 patients. In all studies, joint denervation improved pain and hand function at follow-up (M = 36.8 months, range = 3-90 months). Pooled analysis of 3 studies on the first carpometacarpal joint showed a statistically significant (P < .001) reduction in pain scores from baseline (M = 6.61 ± 2.03) to postoperatively (M = 1.69 ± 1.27). The combined complication rate was 18.8% (n = 36 of 192), with neuropathic pain or unintended sensory loss (8.8%, n = 17 of 192) being the most common. This review suggests that denervation may be an effective and low-morbidity procedure for treating arthritis of the hand. Prospective, comparative studies are required to further understand the outcomes of denervation compared with traditional surgical interventions.
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Affiliation(s)
- Sarah L Zhu
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Brian Chin
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohamed Sarraj
- Division of Orthopedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Eugene Wang
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Emily E Dunn
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
| | - Matthew C McRae
- Division of Plastic Surgery, McMaster University, Hamilton, ON, Canada
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Lipatov KV, Asatryan A, Melkonyan G, Kazantcev AD, Solov’eva EI, Cherkasov UE. Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment. World J Orthop 2022; 13:622-630. [PMID: 36051375 PMCID: PMC9302027 DOI: 10.5312/wjo.v13.i7.622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/19/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Septic arthritis of the hand is a serious disease that often results in dysfunction of the joint or even the need to perform amputation of the finger. They rank second in the frequency of occurrence after lesions of the knee joint. Many points concerning the etiology, the timing of the development of cartilage destruction and the development of osteomyelitis, approaches to surgical treatment, the duration of antibiotic therapy, and the start of rehabilitation measures remain the subject of numerous discussions. Based on a search in the PubMed, Web of Science and Google Scholar databases down to 1990-2021, publications on septic arthritis of the hand were found and analyzed. The following inclusion criteria were used in our review: (1) Septic arthritis of the hand; (2) Published in a peer review journal; (3) Written in English; and (4) Full text version available. Studies were excluded if they met any of the following criteria: (1) Letters; (2) Articles published in abstract form only; and (3) Cadaveric studies. Septic arthritis of the hand was characterized by the most frequent damage to the joints of the index and middle fingers (> 50% of cases). Up to 90% of cases, the infection enters the joint as a result of penetrating trauma, animal bites, etc. Staphylococcus aureus became the most frequently isolated microorganism (30%-55%), and its polyantibiotic-resistant form Methicillin-resistant Staphylococcus aureus was found, according to various sources, from 0% to 73% among all isolated Staphylococcus aureus. In arthritis, Pasteurella multocida (6%-11%) is often isolated as a result of animal bites. Articular cartilage destruction in the experiment developed within 24-48 h after infection. In clinical studies, the development of osteomyelitis was noted when treatment was delayed by more than 10 d. X-ray data during the first two weeks were uninformative. Priority of surgical treatment of septic arthritis. Drainage and surgical treatment, and with the development of osteomyelitis, the implementation of arthrodesis. Antibacterial therapy for 2-4 wk and early start of rehabilitation measures. Timely surgical treatment in combination with antibiotic therapy and rehabilitation makes it possible to obtain a positive result in the treatment of septic arthritis of the hand.
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Affiliation(s)
- Konstantin V Lipatov
- Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Arthur Asatryan
- Wound and Wound Infection Surgery, State Budgetary Institution “City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department”, Moscow 115446, Russia
| | - George Melkonyan
- Department of General Surgery, Physician of The Hospital for War Veterans No 3, Moscow 129336, Russia
| | - Aleksandr D Kazantcev
- Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia
| | - Ekaterina I Solov’eva
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
| | - Urii E Cherkasov
- Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia
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Vonderlind HC, Eisenschenk A, Strüwer J, Millrose M. [Arthrodesis of the distal interphalangeal Joint - a literature Review]. HANDCHIR MIKROCHIR P 2021; 54:5-20. [PMID: 34544198 DOI: 10.1055/a-1560-2677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
This review addresses the arthrodesis of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb with focus on indications, approaches, preparation of the articular surfaces, the angle of arthrodesis, advances and disadvantages of each technique, and postoperative care.
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Affiliation(s)
| | - Andreas Eisenschenk
- Unfallkrankenhaus Berlin Abteilung für Hand-, Replantations- und Mikrochirurgie
| | - Johannes Strüwer
- Klinikum Oldenburg AoR Universitätsklinik für Orthopädie und Unfallchirurgie
| | - Michael Millrose
- Klinikum Garmisch-Partenkirchen, Abteilung für Unfallchirurgie, Sportorthopädie & Kindertraumatologie
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Rüdiger M, Grimm M, Baumgarten K, Kroesen AJ. [Seven days old, open fracture of the proximal phalanx of the thumb with cellulitis : Case report demonstrating a successful surgical treatment of the injury despite complications]. Unfallchirurg 2020; 123:984-987. [PMID: 32930828 DOI: 10.1007/s00113-020-00865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Malte Rüdiger
- Klinik für Chirurgie, Sektion Unfallchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland.
| | - Martin Grimm
- Klinik für Chirurgie, Sektion Unfallchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland
| | - Klaus Baumgarten
- Klinik für Chirurgie, Sektion Unfallchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland
| | - Anton Josef Kroesen
- Klinik für Chirurgie, Sektion Unfallchirurgie, Krankenhaus Porz am Rhein, Urbacher Weg 19, 51149, Köln, Deutschland
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Klemm HT, Wittchen V, Willauschus W, Fuhrmann RA, Hohendorff B. [Joint arthrodesis in functionally favorable position : Considerations on measurement of disability in private accident insurance]. Unfallchirurg 2020; 123:988-998. [PMID: 33108480 DOI: 10.1007/s00113-020-00913-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.
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Affiliation(s)
- H-T Klemm
- Freies Institut für medizinische Begutachtungen, Ludwigstraße 25, 95444, Bayreuth, Deutschland.
- Fachgesellschaft Interdisziplinäre Medizinische Begutachtung (FGIMB e. V.), Hamburg, Deutschland.
| | - V Wittchen
- Dr. Eick & Partner Rechtsanwälte Partnerschaft mbB, Hamm, Deutschland
| | - W Willauschus
- Fachgesellschaft Interdisziplinäre Medizinische Begutachtung (FGIMB e. V.), Hamburg, Deutschland
- alphaMED, Orthopädisch-unfallchirurgische Praxisklinik, Bamberg, Deutschland
| | - R A Fuhrmann
- Fachgesellschaft Interdisziplinäre Medizinische Begutachtung (FGIMB e. V.), Hamburg, Deutschland
- Klinik für Fuß- und Sprunggelenkchirurgie, Rhön-Klinikum Campus Bad Neustadt, Neustadt, Deutschland
| | - B Hohendorff
- Handchirurgie, Abteilung Hand‑, Ästhetische und Plastische Chirurgie, Elbe-Klinikum Stade, Stade, Deutschland
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Leclère FM, Haug L, Meier R, Surke C, Unglaub F, Vögelin E. Non-vascularized partial joint transfer for Finger Proximal Interphalangeal joint reconstruction: a series of 9 patients. Arch Orthop Trauma Surg 2020; 140:139-144. [PMID: 31691006 DOI: 10.1007/s00402-019-03301-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Finger proximal interphalangeal joint (PIP) reconstruction after the destruction of parts of the joint remains challenging. Surgical techniques include implant arthroplasty, arthrodesis, free vascularized joint transfer, and non-vascularized bone and joint transfer. This study analyzes our experience after non-vascularized transfer in terms of range of motion, postoperative rehabilitation, and patient satisfaction. MATERIALS AND METHODS Between 2009 and 2014, ten patients underwent non-vascularized partial joint transfer for PIP joint reconstruction. One of them was lost to follow-up. Included patients had osteochondral partial joint transplants of 25-50% of the toes (n = 4) and the hand (n = 5). Range of motion (ROM), grip-, and pinch-strength were measured at the last follow-up control and compared to the healthy side. Patients were asked to score the pain at rest/ on load on a visual scale (VAS: 0 = no pain; 10 = excruciating pain). Satisfaction self-assessment was evaluated by asking the patients to grade their postoperative result as excellent, very good, good or poor. RESULTS Mean follow-up period was 4.0 years (range 1.2-7.9 years). Mean PIP joint flexion was 93 ± 26° at the last follow-up control. Mean grip- and pinch-strength of the operated side at the last control were, respectively, 43 ± 18 kg and 8 ± 5 kg, close to the healthy side values (45 ± 15 kg and 9 ± 4 kg). Mean pain at rest/on load measured on a visual scale was, respectively, 0.3 ± 1 and 1.8 ± 2. Eight patients (89%) rated their operation as excellent, and one as poor. CONCLUSION In this study, non-vascularized partial joint transfer provides a mobile and stable PIP joint 4 years after reconstruction. The surgical technique presented herein is complex depending on additional injuries but results in great patient satisfaction.
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Affiliation(s)
- Franck M Leclère
- Department of Plastic und Hand Surgery, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Luzian Haug
- Department of Plastic und Hand Surgery, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Rahel Meier
- Department of Plastic und Hand Surgery, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Carsten Surke
- Department of Plastic und Hand Surgery, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Klinik GmbH, Vulpiusstraße 29, 74906, Bad Rappenau, Deutschland
| | - Esther Vögelin
- Department of Plastic und Hand Surgery, Bern University Hospital, Inselspital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
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Saul D, Roch J, Lehmann W, Dresing K. [Oberst's block anesthesia]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 32:18-22. [PMID: 31650198 DOI: 10.1007/s00064-019-00633-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/05/2019] [Accepted: 05/08/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Complete anesthesia of the phalanges of the fingers and toes. INDICATIONS All lesions distal to the metacarpophalangeal/metatarsophalangeal joint. CONTRAINDICATIONS Local infections at the injection site. Lesions proximal to the metacarpophalangeal/metatarsophalangeal joint. TECHNIQUE A subcutaneous deposit of a 0.5-2% local anesthetic is administered dorsoradially and dorsoulnarly at the base of the metacarpophalangeal/metatarsophalangeal joint. With the cannula advanced to palmar, an additional 0.5-1.5 ml is then administered to achieve complete anesthesia. POSTOPERATIVE MANAGEMENT The effect of the local anesthesia is self-limiting. RESULTS The Oberst block results in reliable anesthesia of the finger and toe. All surgical procedures distal to the metacarpophalangeal/metatarsophalangeal joint can be performed without pain.
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Affiliation(s)
- Dominik Saul
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - Jonathan Roch
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - Klaus Dresing
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
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Hohendorff B, Unglaub F, Spies CK, Wegmann K, Müller LP, Ries C. [Surgical approaches to the hand]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:372-383. [PMID: 31359070 DOI: 10.1007/s00064-019-0622-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Accessibility of any anatomical structure of the hand via surgical approach. INDICATIONS Any surgical treatment of the hand. CONTRAINDICATIONS Any contraindication to surgical treatment of the hand. SURGICAL TECHNIQUE Skin incision at the hand with access to any anatomical structure. POSTOPERATIVE MANAGEMENT Postoperative treatment depends on the disease and hand surgery performed.
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Affiliation(s)
- B Hohendorff
- Abteilung für Hand‑, Ästhetische und Plastische Chirurgie, Elbe Klinikum Stade, Bremervörder Straße 111, 21682, Stade, Deutschland.
| | - F Unglaub
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - C K Spies
- Handchirurgie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - K Wegmann
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - L P Müller
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
| | - C Ries
- Unfall‑, Hand- und Ellenbogenchirurgie, Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum zu Köln, Köln, Deutschland
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Staged arthrodesis using the Masquelet technique for osteomyelitis of the finger with articular destruction: a report of two cases. Arch Orthop Trauma Surg 2019; 139:1025-1031. [PMID: 31093754 DOI: 10.1007/s00402-019-03197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Indexed: 02/09/2023]
Abstract
Osteitis of the fingers is a serious infection that needs early diagnosis and appropriate surgical debridement and antibiotic treatment of the infected bone. If the effects of treatments are insufficient, long-term antibiotic treatment and repeated operations could be required. In worst cases, some patients may have to undergo amputation. Recently, the usefulness of the Masquelet technique in extensive traumatic bone defects has been reported. We herein describe two cases of immunocompromised patients with purulent osteitis involving joint destruction of the finger treated by two-stage arthrodesis using the Masquelet technique. They obtained good infection control and better function of the finger than before the operation. Moreover, there was no recurrence of the infection. The Masquelet technique could be an alternative technique for osteitis with high risk of amputation.
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Karl Spies C, Langer M, Hahn P, Peter Müller L, Unglaub F. The Treatment of Primary Arthritis of the Finger and Thumb Joint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:269-275. [PMID: 29739493 PMCID: PMC5954171 DOI: 10.3238/arztebl.2018.0269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/15/2017] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.
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Affiliation(s)
| | - Martin Langer
- Department of Trauma, Hand, and Plastic Surgery, Münster University Hospital, Münster
| | - Peter Hahn
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
| | - Lars Peter Müller
- Department of Orthopedics and Trauma Surgery, Cologne University Hospital, Cologne
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
- Medical Faculty Mannheim, University of Heidelberg, Mannheim
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