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Lane JC, Wilkinson AL, Giddins G, Horwitz MD. Preventable hand injuries: A national audit. JPRAS Open 2023; 38:305-312. [PMID: 38039295 PMCID: PMC10684376 DOI: 10.1016/j.jpra.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/01/2023] [Indexed: 12/03/2023] Open
Abstract
Little is known of the scale of avoidable injuries presenting to medical services on a national level in the UK. This study aimed to assess the type and incidence of preventable wrist and hand injuries (as defined by the core research team) at a national level in the UK. 28 UK hospitals undertook a service evaluation of all hand trauma cases presenting to their units over a 2 week period in early 2021 identifying demographical and aetiological information about injuries sustained. 1909 patients were included (184 children) with a median age of 40 (IQR 25-59) years. The commonest five types of injury were fractures of the wrist; single phalangeal or metacarpal fractures; fingertip injuries; and infection, with the most common mechanisms being mechanical falls and manual labour. This is the first extensive survey of preventable hand injuries in the UK, identifying a need for further work into prevention to reduce healthcare burden and cost. 50% of injuries presenting to hand surgeons are preventable, with the most common injuries being single fractures of the wrist, phalanx and metacarpal. Few preventable injuries were related to alcohol or narcotic intoxication. Further research is needed to identify how to initiate injury prevention measures for hand injuries, particularly focussed towards hand fracture prevention.
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Affiliation(s)
- Jennifer C.E. Lane
- Barts Bone & Joint Health, Blizard Institute, Queen Mary University of London, 4 Newark Street, E1 2AT, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK
| | | | - Grey Giddins
- Royal United Hospital, Combe Park, Bath, BA1 3NG, UK
| | - Maxim D. Horwitz
- Chelsea and Westminster Hospital, 369 Fulham Road, SW10 9NH London, UK
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2
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Harries K, Osmani HT, Patel J, Robinson P, Horwitz MD, Ahmed N. The patient with an acute painful wrist. Br J Hosp Med (Lond) 2023; 84:1-9. [PMID: 38019207 DOI: 10.12968/hmed.2023.0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Patients with wrist pain commonly present to primary care and emergency departments. A detailed history and examination, alongside relevant imaging, will help find the correct diagnosis and ensure that patients receive the correct treatment in a timely manner. This article summarises the key points in history and examination and the role of imaging, including suggestions of which modality should be requested. Finally, important acute pathologies are highlighted, including fractures, soft tissue injuries and infection, with examples of their relevant imaging.
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Affiliation(s)
- Katherine Harries
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Humza T Osmani
- Department of Trauma and Orthopaedics, Addenbrookes Hospital, Cambridge, UK
| | - Jugal Patel
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Philip Robinson
- Department of Radiology, Chapel Allerton Hospital, Leeds, UK
| | - Maxim D Horwitz
- Department of Trauma and Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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3
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Abstract
The purpose of this review article is to provide an update on the realm of emerging technology available for the assessment of dynamic functional movement of the hand and upper limb. A critical overview of the literature and a conceptual framework for use of such technologies is proposed. The framework explores three broad purpose categories including customization of care, functional surveillance and interventions through biofeedback strategies. State-of-the-art technologies are described, from basic activity monitors to feedback-enabled robotic gloves, along with exemplar trials and clinical applications. The future of technologies innovation in hand pathology is proposed in the context of the current obstacles and opportunities for hand surgeons and therapists.
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Affiliation(s)
- Aviva L Wolff
- Leon Root, MD Motion Analysis Laboratory, Department of Rehabilitation, Hospital for Special Surgery, New York, NY, USA
| | | | - Simon Farnebo
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maxim D Horwitz
- Chelsea & Westminster Hospital, London, United Kingdom; Imperial College London, London, UK
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4
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Abstract
Artificial intelligence (AI) in hand surgery is an emerging and evolving field that will likely play a large role in the future care of our patients. However, there remain several challenges to makes this technology meaningful, acceptable and usable at scale. In this review article, we discuss basic concepts in AI, including challenges and key considerations, provide an update on how AI is being used in hand and wrist surgery and propose potential future applications. The aims are to equip clinicians and researchers with the basic knowledge needed to understand and explore the incorporation of AI in hand surgery within their own practice and recommends further reading to develop knowledge in this emerging field.
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Affiliation(s)
- Robert Miller
- Department of Hand and Plastic surgery department, Chelsea and Westminster Hospital, London, UK.,Fellow in Clinical Artificial Intelligence, The London Medical Imaging & AI Centre for Value Based Healthcare, London, UK
| | - Simon Farnebo
- Department of Plastic Surgery, Hand Surgery, and Burns, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maxim D Horwitz
- Department of Hand and Plastic surgery department, Chelsea and Westminster Hospital, London, UK
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5
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Bodansky DMS, Sandow MJ, Volk I, Luria S, Verstreken F, Horwitz MD. Insights and trends review: the role of three-dimensional technology in upper extremity surgery. J Hand Surg Eur Vol 2023; 48:383-395. [PMID: 36748271 DOI: 10.1177/17531934221150498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of three-dimensional (3-D) technology in upper extremity surgery has the potential to revolutionize the way that hand and upper limb procedures are planned and performed. 3-D technology can assist in the diagnosis and treatment of conditions, allowing virtual preoperative planning and surgical templating. 3-D printing can allow the production of patient-specific jigs, instruments and implants, allowing surgeons to plan and perform complex procedures with greater precision and accuracy. Previously, cost has been a barrier to the use of 3-D technology, which is now falling rapidly. This review article will discuss the current status of 3-D technology and printing, including its applications, ethics and challenges in hand and upper limb surgery. We have provided case examples to outline how clinicians can incorporate 3-D technology in their clinical practice for congenital deformities, management of acute fracture and malunion and arthroplasty.
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Affiliation(s)
- David M S Bodansky
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Ido Volk
- Hadassah Medical Organisation, Jerusalem, Israel
| | - Shai Luria
- Hadassah Medical Organisation, Jerusalem, Israel
| | | | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK
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6
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Li LX, Kedgley AE, Horwitz MD. A Review of the Use of 3D Printing Technology in Treatment of Scaphoid Fractures. J Hand Surg Asian Pac Vol 2023; 28:22-33. [PMID: 36803332 DOI: 10.1142/s2424835523500042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Background: Three-dimensional (3D) printing technology is increasingly commercially viable for pre-surgical planning, intraoperative templating, jig creation and customised implant manufacture. The challenging nature of scaphoid fracture and nonunion surgery make it an obvious target. The aim of this review is to determine the use of 3D printed technologies in the treatment of scaphoid fractures. Methods: This is a review of the Medline, Embase and Cochrane Library databases examining studies aimed at therapeutic use of 3D printing, also known as rapid prototyping or additive technology, in the treatment of scaphoid fractures. All studies published up to and including November 2020 were included in the search. Relevant data extracted included modality of use (as template/model/guide/prosthesis), operative time, accuracy of reduction, radiation exposure, follow-up duration, time to union, complications and study quality. Results: A total of 649 articles were identified, of which 12 met the full inclusion criteria. Analysis of the articles showed that 3D printing techniques can be utilised in myriad ways to aid planning and delivery of scaphoid surgery. Percutaneous guides for Kirschner-wire (K-wire) fixation of non-displaced fractures can be created; custom guides can be printed to aid reduction of displaced or non-united fractures; patient-specific total prostheses may recreate near-normal carpal biomechanics and a simple model may help graft harvesting and positioning. Conclusions: This review found that the use of 3D printed patient-specific models and templates in scaphoid surgery can improve accuracy and speed, and reduce radiation exposure. 3D printed prostheses may also restore near-normal carpal biomechanics without burning bridges for potential future procedures. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Lily X Li
- Department of Trauma and Orthopaedics, St Mary's Hospital, London, UK
| | | | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
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7
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Horwitz MD. Commentary on: Li et al. Evaluation of a convolutional neural network to identify scaphoid fractures on radiographs. J Hand Surg Eur. 2022, 48. J Hand Surg Eur Vol 2022; 48:451-452. [PMID: 36524253 DOI: 10.1177/17531934221143434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
Adolescence is a difficult time, both physically and emotionally. Rapid growth coupled with physical changes in the background of high levels of activity can be overwhelming. Meanwhile, unfamiliar life stressors coupled with undeveloped compensatory mechanisms can lead to overwhelming anxiety and emotional distress. Emotional factors can make injuries and overuse syndromes feel more catastrophic. Occasionally, an adolescent's emotional distress can manifest physically, without antecedent injury or physiologic cause. Understanding the psychological milieu is as important as understanding the disease processes that can affect adolescents if one hopes to manage these patients effectively.
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Affiliation(s)
- Anna Watson
- Chelsea & Westminster Hospital, London, United Kingdom
| | | | - Maxim D Horwitz
- Chelsea & Westminster Hospital, London, United Kingdom; Imperial College London, London, United Kingdom
| | - Sarah K Tolerton
- Sydney Hospital and Prince of Wales Hospital, Randwick, Australia; University of Sydney, Camperdown, Australia
| | - Dan A Zlotolow
- Thomas Jefferson University School of Medicine, Philadelphia, PA; Hospital for Special Surgery, New York, NY; Shriners Hospital for Children Philadelphia, Philadelphia, PA.
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9
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Vissers G, Rusli WMR, Scarborough A, Horwitz MD, McArthur GJ, Kedgley AE. A study to compare strengths of cadaveric tendon repairs with round-bodied and cutting needles. J Hand Surg Eur Vol 2022; 47:481-485. [PMID: 34878950 DOI: 10.1177/17531934211064201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This human cadaver study investigated whether flexor tendon repairs performed with round-bodied needles had a higher risk of pull-out compared with those performed with cutting needles. Forty human cadaver tendons were repaired (20 with each type of needle), subjected to tensile traction testing and evaluated by failure load and mode of failure. The average failure load was 50 N (SD 13 N) for tendons repaired with round-bodied needles, compared with 49 N (SD 16 N) for tendons repaired with cutting needles. Round-bodied needles resulted in more suture pull-out (18 out of 20 tendons) than cutting needles (6 out of 20 tendons). We found no differences in failure load, but significant differences in the mode of failure between round-bodied and cutting needles when used for cadaveric flexor tendon repair.
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Affiliation(s)
- Gino Vissers
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Wan M R Rusli
- Department of Bioengineering, Imperial College London, London, UK
| | - Alexander Scarborough
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Maxim D Horwitz
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Gordon J McArthur
- Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, UK
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10
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Shaerf DA, Chae WJ, Sharif-Razavian R, Vardakastani V, Kedgley AE, Horwitz MD. Do "Anatomic" Distal Ulna Plating Systems Fit the Distal Ulna Without Causing Soft Tissue Impingement? Hand (N Y) 2022; 17:506-511. [PMID: 32517515 PMCID: PMC9112735 DOI: 10.1177/1558944720930302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Distal ulna fracture fixation plates commonly cause irritation, necessitating removal, due to the narrow area between the ulna articular cartilage and the extensor carpi ulnaris. This study defines the safe zone for plate application and determines whether wrist position affects risk of impingement. Methods: Four different distal ulna anatomic plates (Acumed, Medartis, Skeletal Dynamics, and Synthes) were applied to 12 cadaveric specimens. Safe zone size was measured in circumferential distance and angular arc. Impingement was examined in flexion and extension in neutral, pronation, and supination. Results: The distal ulna safe zone has dimensions of a 92° arc and perimeter circumference of 15 mm. Cumulative extensor carpi ulnaris (ECU) impingement occurred in 0% of the 6 simulated wrist/forearm positions for the Acumed plate, 22% for the Synthes plate, 31% for the Skeletal Dynamics plate, and 68% for the Medartis plate. Impingement was most common in supination. Likelihood of ECU impingement significantly decreased in the following order; Medartis > Skeletal Dynamics > Synthes > Acumed. Conclusion: The ECU tendon's mobility can cause impingement on ulnarly placed distal ulna plates. Intra-operative testing should be performed in supination. Take home points regarding each plate from the 4 different manufacturers: contouring of Medartis plates, when placed ulnarly, is mandatory. The Acumed plate impinged the least but is not designed for far-distal fractures. The Synthes plate is least bulky but not suitable for proximal fractures. The Skeletal Dynamics plate appeared the most versatile with a reduced incidence of impingement compared to other ulnarly based plates.
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Affiliation(s)
- Daniel A. Shaerf
- London North West University Healthcare NHS Trust, Middlesex, UK,Daniel A. Shaerf, Department of Trauma and Orthopaedics, London North West University Healthcare NHS Trust, Uxbridge Road, Middlesex UB1 3HW, UK.
| | | | | | | | | | - Maxim D. Horwitz
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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11
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Low R, Young K, Verani L, Cotton DT, Welman T, Moore LSP, Horwitz MD. Point-of-care testing for tetanus immunity: a systematic review and meta-analysis. Emerg Med J 2022; 39:emermed-2021-211624. [PMID: 35379750 DOI: 10.1136/emermed-2021-211624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 03/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The current standard of care for tetanus prophylaxis management in patients with open wounds likely results in overtreatment and unnecessary costs. Point-of-care immunochromatographic tests, known as Tetanus Quick Sticks (TQS), have been developed to qualitatively measure tetanus immunoglobulin levels. Multiple studies advocate their use in EDs. We aim to evaluate the diagnostic accuracy and cost-effectiveness of TQS to assess their relevance in frontline emergency care. METHODS A systematic review was undertaken following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted in MEDLINE, Embase, Global Health, The Health Management Information Consortium and The Cochrane Library. Studies were eligible if sensitivity, specificity or cost-efficacy of TQS was reported. At least two authors independently assessed and extracted data from each study. A meta-analysis was conducted to evaluate summary sensitivity and specificity estimates for TQS. RESULTS 12 studies were suitable for inclusion (n=1 662 865 participants): 1 modelling and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy; the summary estimate for sensitivity was 90% (95% CI, 89% to 90%) with specificity 97% (95% CI, 95% to 100%). Six studies investigated cost-efficacy, reporting lower healthcare costs when using TQS instead of the current method of vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration. Based on the current NHS supply chain data, TQS use could save £173.05 per tetanus-prone patient. CONCLUSION TQS could confer the greatest cost savings if used in combination with vaccination history in patients with tetanus-prone wounds. A quality assurance process is recommended prior to implementation of TQS in EDs.
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Affiliation(s)
| | | | | | | | | | - Luke S P Moore
- Imperial College London, London, UK
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Maxim D Horwitz
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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12
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Abstract
Background: Trigger finger has a prevalence of 2% to 3% in the general population. Although anecdotal evidence exists, there is a lack of conclusive data that prove a relationship between repetitive power grip and flexion with triggering. Ocean rowing is becoming a popular sport, with the race across the Atlantic alone attracting more than 100 participants annually. Anecdotal reports suggest ocean rowing may be a significant cause of trigger finger. We aimed to identify whether the sport causes an increased prevalence of triggering, whether there were any alleviating or compounding factors, and, finally, whether there was any effect on performance. Methods: A prospective observational study was carried out. A questionnaire was sent to all participants of the Talisker Whisky Atlantic Challenge 2018, which included a trigger finger self-scoring system and the Oslo Sports Trauma Center Overuse Injury Questionnaire. Results: Responses were received from 67 rowers (83% response rate). Age ranged from 21 to 62 years, with a mean of 40 years. In all, 49.3% had clinical triggering, with 79.3% reporting bilateral symptoms. The length of continuous rest time had a significant impact on the incidence of finger triggering and disease stage (P = .0275 and .0353, respectively; multivariate logistic regression). High-grade triggering had a more negative effect on rowing performance than low grade or no triggering (not significant). Conclusion: Ocean rowers suffered a 15-fold increase in trigger finger prevalence compared with the general population. This was increased in those who took shorter, more frequent rest periods. This study provides new conclusive evidence that the repetitive power grip and flexion involved in rowing increase the prevalence of trigger finger.
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Affiliation(s)
- Ted Welman
- Chelsea and Westminster Hospital NHS
Foundation Trust, London, UK,Barts Health NHS Foundation Trust,
London, UK,Ted Welman, Department of Plastic Surgery,
The Royal London Hospital, Barts Health NHS Foundation Trust, Whitechapel Road,
London E1 1BB, UK.
| | | | | | - Maxim D. Horwitz
- Chelsea and Westminster Hospital NHS
Foundation Trust, London, UK
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13
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Morgan C, Sugand K, Ashdown T, Nathoo N, MacFarlane R, Dyke R, Park C, Aframian A, Domos P, Horwitz MD, Sarraf KM, Dattani R. Impact of the National Lockdown Due to the COVID-19 Pandemic On Upper Limb Trauma Workload in Central London: A Multi-Centre Longitudinal Observational Study During Implementation and Ease of National Lockdown. Arch Bone Jt Surg 2022; 10:23-31. [PMID: 35291242 PMCID: PMC8889424 DOI: 10.22038/abjs.2021.53205.2639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 07/07/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND This study assessed the impact of the COVID-19 pandemic on acute upper limb referrals and operative case-mix at the beginning and ease of British lockdown. METHODS A longitudinal multicentre observational cohort study was conducted for both upper limb trauma referrals and operative case-mix over a 12-week period (6 weeks from the beginning and 6 weeks from the ease of the national lockdown). Statistical analysis included median (± median absolute deviation), risk and odds ratios, and Fisher's exact test to calculate the statistical significance, set at p ≤ 0.05. RESULTS There was a 158% (n = 456 vs. 177) increase in upper limb referrals and 133% (n = 91 vs. 39) increase in the operative trauma caseload at the ease of lockdown compared with its commencement. An increase in sporting injuries was demonstrated (p=0.02), specifically cycling (p=0.004, OR=2.58). A significant increase in COVID-19 testing was demonstrated during the ease of lockdown (p=0.0001) with more patients having their management changed during the beginning of the pandemic (9.6% vs. 0.7%, p=0.0001). Of these patients, 47% went on to have delayed surgery within 6 months. No patients who underwent surgery tested positive for COVID-19 infection within 14 days post-operatively and no mortalities were recorded at 30 days. CONCLUSION The ease of lockdown has seen upper limb referrals and operations more than double compared to early lockdown. With no patients testing positive for COVID-19 within 14 days of the procedure, this demonstrates that having upper limb surgery during the current pandemic is safe.
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Affiliation(s)
- Catrin Morgan
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | - Kapil Sugand
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Thomas Ashdown
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Nikita Nathoo
- Barnet Hospital, Royal Free NHS Foundation Trust, London, England UK
| | | | - Rory Dyke
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Chang Park
- Imperial College Healthcare NHS Trust, London, England, UK
| | - Arash Aframian
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | - Peter Domos
- Barnet Hospital, Royal Free NHS Foundation Trust, London, England UK
| | - Maxim D. Horwitz
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
| | | | - Rupen Dattani
- Chelsea and Westminster NHS Foundation Trust, London, England, UK
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14
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Miranda BH, Talwar C, Horwitz MD, Smith PJ. Aggressive paediatric camptodactyly: the evolution of a proposed treatment algorithm. J Plast Reconstr Aesthet Surg 2022; 75:1907-1915. [DOI: 10.1016/j.bjps.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/21/2021] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
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15
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Affiliation(s)
- Justine Silber
- Birmingham Medical School, University
of Birmingham, Edgbaston, UK,
| | - Grey Giddins
- Department of Orthopaedic Surgery,
Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - Maxim D. Horwitz
- Department of Hand Surgery, Chelsea and
Westminster Hospital, London, UK
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16
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Rusli WMR, Mirza E, Tolerton S, Yong S, Johnson R, Horwitz MD, Kedgley AE. Ligamentous constraint of the first carpometacarpal joint. J Biomech 2021; 128:110789. [PMID: 34653871 DOI: 10.1016/j.jbiomech.2021.110789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
To examine the role of the ligaments in maintaining stability of the first carpometacarpal (CMC) joint, a sequential ligament sectioning study of sixteen specimens was performed. While a small compressive force was maintained, loads were applied to displace each specimen in four directions - volar, dorsal, radial, and ulnar. Translations of the specimen in both dorsal-volar and radial-ulnar axes were measured. Initially, the tests were conducted with the specimen intact. These tests were then repeated following sectioning of the CMC anterior oblique ligament (AOL), ulnar collateral ligament (UCL), intermetacarpal ligament (IML) and dorsal radial ligament (DRL). The first CMC joint translation was increased in the absence of IML and DRL (p < 0.05). Both IML and DRL were important in constraining the first CMC joint translation against external applied loads. Potential applications of these findings include the treatment of joint hypermobility and the reduction or delay of onset or progression of first CMC joint osteoarthritis.
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Affiliation(s)
- Wan M R Rusli
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Eushaa Mirza
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Sarah Tolerton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Sarah Yong
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Riem Johnson
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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Razavian RS, Dreyfuss D, Katakura M, Horwitz MD, Kedgley AE. An in vitro hand simulator for simultaneous control of hand and wrist movements. IEEE Trans Biomed Eng 2021; 69:975-982. [PMID: 34495828 DOI: 10.1109/tbme.2021.3110893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A human hand is a complex biomechanical system, in which bones, ligaments, and musculotendon units dynamically interact to produce seemingly simple motions. A new physiological hand simulator has been developed, in which electromechanical actuators apply load to the tendons of extrinsic hand and wrist muscles to recreate movements in cadaveric specimens in a biofidelic way. This novel simulator simultaneously and independently controls the movements of the wrist (flexion/extension and radio-ulnar deviation) and flexion/extension of the fingers and thumb. Control of these four degrees of freedom (DOF) is made possible by actuating eleven extrinsic muscles of the hand. The coupled dynamics of the wrist, fingers, and thumb, and the over-actuated nature of the human musculoskeletal system make feedback control of hand movements challenging. Two control algorithms were developed and tested. The optimal controller relies on an optimization algorithm to calculate the required tendon tensions using the collective error in all DOFs, and the action-based controller loads the tendons solely based on their actions on the controlled DOFs (e.g., activating all flexors if a flexing moment is required). Both controllers resulted in hand movements with small errors from the reference trajectories (<3.4); however, the optimal controller achieved this with 16% lower total force. Owing to its simpler structure, the action-based controller was extended to enable feedback control of grip force. This simulator has been shown to be a highly repeatable tool (<0.25 N and <0.2 variations in force and kinematics, respectively) for in vitro analyses of human hand biomechanics.
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18
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Grant Y, Freilich S, Horwitz MD, Shemesh D, Crane J. Carpal tunnel syndrome in patients with arteriovenous fistula for haemodialysis: A narrative review of the current literature. J Vasc Access 2021; 22:795-800. [PMID: 32779515 PMCID: PMC8392763 DOI: 10.1177/1129729820948690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/09/2020] [Indexed: 12/05/2022] Open
Abstract
The ideal choice of vascular access in patients requiring haemodialysis is an arteriovenous fistula. However, an important often under-reported complication encountered at follow-up is symptoms of tingling or numbness in the hand. This may represent carpal tunnel syndrome, impairment of the median nerve as it traverses through the carpal tunnel at the wrist by focal compression of this nerve. Contributory factors in the presence of an arteriovenous fistula may include venous hypertension and varying steal syndrome phenomena provoking micro-ischaemia. Studies that investigated the evolution of carpal tunnel syndrome in haemodialysis patients with an arteriovenous fistula revealed that the frequency of carpal tunnel syndrome associated with an arteriovenous fistula on haemodialysis ranged from 10.4% to 42.6%. An association between duration of haemodialysis with arteriovenous fistula and carpal tunnel syndrome development was also observed. Surgical release of carpal tunnel provided complete relief of paraesthesia in all treated patients in the examined, demonstrating an alleviation of symptoms and improved function of hand and quality of life in patients with an arteriovenous fistula. However, the aetiology and risk factors for development of carpal tunnel syndrome remain unclear and further studies should attempt to elucidate the pathophysiology of this occurrence in the presence of arteriovenous fistulas.
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Affiliation(s)
- Yasmin Grant
- Department of Transplant Surgery, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Simon Freilich
- Department of Clinical Neurophysiology, Luton and Dunstable University Hospital, NHS Foundation Trust, Luton, UK
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital NHS Trust, London, UK
| | - David Shemesh
- Department of Surgery and Haemodialysis Access Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Jeremy Crane
- Department of Transplant Surgery, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
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Low R, Young K, Verani L, Cotton DT, Welman T, Moore L, Horwitz MD. 540 Point of Care Testing for Tetanus Immunity: A Systematic Review. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
All patients presenting to emergency departments (EDs) with traumatic injuries require tetanus immunity assessments. Inaccurate tetanus vaccination history based on patient recall incurs unnecessary costs on the NHS. Point-of-care immunochromatographic tests (Tetanus Quick Sticks [TQS]) quickly identify tetanus immunity status. We aim to evaluate the diagnostic accuracy and cost-efficacy of TQS to assess their relevance in emergency care.
Method
The systematic review followed PRISMA guidelines. A retrospective search of MEDLINE, Embase, Global Health, HMIC and The Cochrane Library was conducted. Studies were eligible if sensitivity, specificity, or cost-efficacy of TQS were reported. At least two authors independently analysed the data from each study.
Results
12 studies were suitable for inclusion (n = 1,662,865 participants): one retrospective and 11 prospective observational cohort studies. Eight studies assessed diagnostic accuracy with the median sensitivity at 86% (55-100) and the median specificity at 97.5% (1-100). All six studies investigating cost-efficacy reported greater savings when using TQS instead of using vaccination history, due to a decrease in unnecessary tetanus vaccine and immunoglobulin administration.
Conclusions
TQS is a safe diagnostic tool, especially when used by trained operators. TQS widely reduces costs in comparison to traditional vaccination history. We recommend the use of TQS in Emergency Departments throughout the NHS.
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Affiliation(s)
- R Low
- Imperial College London, London, United Kingdom
| | - K Young
- Imperial College London, London, United Kingdom
| | - L Verani
- Imperial College London, London, United Kingdom
| | - D T Cotton
- Imperial College London, London, United Kingdom
| | - T Welman
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- Department of Plastic Surgery, The Royal London Hospital, Barts Health NHS Foundation Trust, London, United Kingdom
| | - L Moore
- Imperial College London, London, United Kingdom
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
- North West London Pathology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - M D Horwitz
- Hand Unit Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
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20
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Geoghegan L, Horwitz MD, Dukan R. Re: Dukan R, Krief E, Nizard R. Distal radius fracture volar locking plate osteosynthesis using wide-awake local anaesthesia. J Hand Surg Eur. 2020, 45: 857-63. J Hand Surg Eur Vol 2021; 46:438-439. [PMID: 33870780 DOI: 10.1177/1753193420982897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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21
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Geoghegan L, Scarborough A, Rodrigues JN, Hayton MJ, Horwitz MD. Return to Sport After Metacarpal and Phalangeal Fractures: A Systematic Review and Evidence Appraisal. Orthop J Sports Med 2021; 9:2325967120980013. [PMID: 33709003 PMCID: PMC7907947 DOI: 10.1177/2325967120980013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/11/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Fractures of the metacarpals and phalanges account for more than half of all upper extremity fractures sustained by competitive athletes. PURPOSE To determine which management strategy is best for expediting return to preinjury levels of competition in adult athletes with metacarpal and/or phalangeal fractures. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A methodology compliant with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) was used. A custom search strategy was designed and applied to MEDLINE and In-Process, Embase, EMCARE, and CINAHL. RESULTS Overall, 3135 records were identified, of which 8 met full inclusion criteria. All patients returned to preinjury levels of competition, at a mean of 30.6 days for phalangeal fractures and 21.9 days for metacarpal fractures. Meta-analysis demonstrated delayed return-to-sport time for operatively managed metacarpal fractures as compared with nonoperatively managed ones (28.5 vs 22.0 days). All studies were of fair or poor quality, and none were randomized. CONCLUSION Optimal management strategies for athletes with metacarpal and phalangeal fractures remain equivocal. Injury, treatment, and sport-specific factors may confound results and preclude accurate estimation of optimal treatment strategies at present.
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Affiliation(s)
- Luke Geoghegan
- Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | | | | | - Mike J. Hayton
- Department of Trauma, Orthopaedic and Hand Surgery, Wrightington,
Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Maxim D. Horwitz
- Hand Management Unit, Chelsea and Westminster Hospital, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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22
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Shah DS, Horwitz MD, Kedgley AE. Extensor retinaculum excision does not affect wrist tendon forces: a cadaveric simulator study. J Hand Surg Eur Vol 2020; 45:986-988. [PMID: 32507003 PMCID: PMC7583437 DOI: 10.1177/1753193420928781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Darshan S. Shah
- Department of Bioengineering, Imperial College London, London, UK
| | - Maxim D. Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
| | - Angela E. Kedgley
- Department of Bioengineering, Imperial College London, London, UK, Twitter handles: @akedgley, @maximhorwitz
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23
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Scarborough A, Geoghegan L, Horwitz MD, Naqui Z. Implementation of virtual consultation for hand surgeons and therapists: an international survey and future implications. J Hand Surg Eur Vol 2020; 45:1005-1006. [PMID: 32594824 DOI: 10.1177/1753193420934679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Luke Geoghegan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
| | - Zaf Naqui
- The Manchester Hand Centre, Salford Royal Hospital, Salford, UK
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Affiliation(s)
- Christopher P Little
- Orthopaedics & Trauma, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Margaret E Birks
- Sheffield Hand Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
| | | | - Chye Yew Ng
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - David Warwick
- Orthopaedics, University Hospital Southampton, Winchester, UK
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25
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Affiliation(s)
| | - Margaret E. Birks
- Sheffield Hand Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Yorkshire, UK
| | | | - Chye Yew Ng
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - David Warwick
- Orthopaedics, University Hospital Southampton, Winchester, UK
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26
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Tolerton SK, Sinisi M, O’Donnell P, Horwitz MD. Ulnar Nerve Entrapment at Elbow in an Adult Patient with Macrodactyly. J Hand Surg Asian Pac Vol 2020; 25:236-239. [DOI: 10.1142/s2424835520720078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We describe a case of an adult patient presenting with cubital tunnel syndrome in the setting of previously undiagnosed macrodactyly. Early diagnosis and management of macrodactyly is important to help prevent symptoms associated with compromised peripheral nerves and reduce the likelihood of the permanent motor and sensory sequelae of prolonged nerve compression.
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Affiliation(s)
- Sarah K. Tolerton
- Hand Unit, Chelsea and Westminster Hospital, London, UK
- Royal National Orthopaedic Hospital, Stanmore, UK
| | - Marco Sinisi
- Royal National Orthopaedic Hospital, Stanmore, UK
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27
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McKean AR, Batten G, Macneal P, Rahman SM, Moore LSP, Horwitz MD. Utilising multiplex PCR technology for rapid microbial diagnosis in hand and upper limb infections. J Plast Reconstr Aesthet Surg 2020; 74:223-243. [PMID: 32527667 PMCID: PMC7247460 DOI: 10.1016/j.bjps.2020.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew R McKean
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK.
| | - Gemma Batten
- Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Peter Macneal
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Shakeel M Rahman
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
| | - Luke S P Moore
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK; North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, UK
| | - Maxim D Horwitz
- Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, London, SW10 9NH, UK
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Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. The Effect of Surgical Treatments for Trapeziometacarpal Osteoarthritis on Wrist Biomechanics: A Cadaver Study. J Hand Surg Am 2020; 45:389-398. [PMID: 31733980 PMCID: PMC7198980 DOI: 10.1016/j.jhsa.2019.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 07/06/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Studies have shown the effects of surgical treatments for trapeziometacarpal osteoarthritis on thumb biomechanics; however, the biomechanical effects on the wrist have not been reported. This study aimed to quantify alterations in wrist muscle forces following trapeziectomy with or without ligament reconstruction and replacement. METHODS A validated physiological wrist simulator replicated cyclic wrist motions in cadaveric specimens by applying tensile loads to 6 muscles. Muscle forces required to move the intact wrist were compared with those required after performing trapeziectomy, suture suspension arthroplasty, prosthetic replacement, and ligament reconstruction with tendon interposition (LRTI). RESULTS Trapeziectomy required higher abductor pollicis longus forces in flexion and higher flexor carpi radialis forces coupled with lower extensor carpi ulnaris forces in radial deviation. Of the 3 surgical reconstructions tested post-trapeziectomy, wrist muscle forces following LRTI were closest to those observed in the intact case throughout the range of all simulated motions. CONCLUSIONS This study shows that wrist biomechanics were significantly altered following trapeziectomy, and of the reconstructions tested, LRTI most closely resembled the intact biomechanics in this cadaveric model. CLINICAL RELEVANCE Trapeziectomy, as a standalone procedure in the treatment of trapeziometacarpal osteoarthritis, may result in the formation of a potentially unfilled trapezial gap, leading to higher wrist muscle forces. This biomechanical alteration could be associated with clinically important outcomes, such as pain and/or joint instability.
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Affiliation(s)
- Darshan S. Shah
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Claire Middleton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Sabahat Gurdezi
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Maxim D. Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Angela E. Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom,Corresponding author: Angela E. Kedgley, MS. PhD, Department of Bioengineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom.
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29
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O'Hara N, Opel S, Horwitz MD. Re: Kang et al. Wrist inflammation: a retrospective comparison between septic and non-septic arthritis. J Hand Surg Eur. 2018, 43: 431-7. J Hand Surg Eur Vol 2020; 45:94-96. [PMID: 31510856 DOI: 10.1177/1753193419873552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Niall O'Hara
- Hand Management Unit, Chelsea and Westminster Hospital, London, UK
| | - Sophia Opel
- Hand Management Unit, Chelsea and Westminster Hospital, London, UK
| | - Maxim D Horwitz
- Hand Management Unit, Chelsea and Westminster Hospital, London, UK
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30
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Affiliation(s)
| | - Robert Miller
- Department of Plastic Surgery and Hand Surgery, Chelsea and Westminster Hospital, London, UK
| | | | - Evangelia Protopapa
- Department of Tissue and Energy, UCL Division of Surgery and Interventional Sciences, London, UK
| | - Maxim D Horwitz
- Department of Plastic Surgery and Hand Surgery, Chelsea and Westminster Hospital, London, UK
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31
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Affiliation(s)
- Daniel A Shaerf
- 1 Hand & Wrist Unit, Chelsea & Westminster Hospital, London, UK
| | | | - Maxim D Horwitz
- 1 Hand & Wrist Unit, Chelsea & Westminster Hospital, London, UK
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32
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Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. Alterations to wrist tendon forces following flexor carpi radialis or ulnaris sacrifice: a cadaveric simulator study. J Hand Surg Eur Vol 2018; 43:886-888. [PMID: 29950135 PMCID: PMC6139988 DOI: 10.1177/1753193418783176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Darshan S. Shah
- Department of Bioengineering, Imperial College London, London, UK
| | - Claire Middleton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
| | - Sabahat Gurdezi
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
| | - Maxim D. Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, UK
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33
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Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. The importance of abductor pollicis longus in wrist motions: A physiological wrist simulator study. J Biomech 2018; 77:218-222. [PMID: 30054091 PMCID: PMC6085116 DOI: 10.1016/j.jbiomech.2018.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/01/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022]
Abstract
The abductor pollicis longus (APL) is one of the primary radial deviators of the wrist, owing to its insertion at the base of the first metacarpal and its large moment arm about the radioulnar deviation axis. Although it plays a vital role in surgical reconstructions of the wrist and hand, it is often neglected while simulating wrist motions in vitro. The aim of this study was to observe the effects of the absence of APL on the distribution of muscle forces during wrist motions. A validated physiological wrist simulator was used to replicate cyclic planar and complex wrist motions in cadaveric specimens by applying tensile loads to six wrist muscles - flexor carpi radialis (FCR), flexor carpi ulnaris, extensor carpi radialis longus (ECRL), extensor carpi radialis brevis, extensor carpi ulnaris (ECU) and APL. Resultant muscle forces for active wrist motions with and without actuating the APL were compared. The absence of APL resulted in higher forces in FCR and ECRL - the synergists of APL - and lower forces in ECU - the antagonist of APL. The altered distribution of wrist muscle forces observed in the absence of active APL control could significantly alter the efficacy of in vitro experiments conducted on wrist simulators, in particular when investigating those surgical reconstructions or rehabilitation of the wrist heavily reliant on the APL, such as treatments for basal thumb osteoarthritis.
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Affiliation(s)
- Darshan S Shah
- Department of Bioengineering, Imperial College London, London, United Kingdom.
| | - Claire Middleton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Sabahat Gurdezi
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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Shah DS, Middleton C, Gurdezi S, Horwitz MD, Kedgley AE. The effects of wrist motion and hand orientation on muscle forces: A physiologic wrist simulator study. J Biomech 2017; 60:232-237. [PMID: 28669547 PMCID: PMC5555257 DOI: 10.1016/j.jbiomech.2017.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback – hybrid control and cascade control – were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower’s motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces (p < 0.017) and higher out-of-plane kinematic errors (p < 0.007), as compared to the vertically upward or downward orientations. Muscle forces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction (p = 0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction (p = 0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation.
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Affiliation(s)
- Darshan S Shah
- Department of Bioengineering, Imperial College London, London, United Kingdom.
| | - Claire Middleton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Sabahat Gurdezi
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom.
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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Hunter AR, Horwitz MD, Halsey TJ. Hand trauma always requires ring removal. Br J Hosp Med (Lond) 2014; 75:715. [PMID: 25488539 DOI: 10.12968/hmed.2014.75.12.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A R Hunter
- Specialist Registrar in Trauma and Orthopaedics, Hand Unit, Department of Plastic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London SW10 9NH
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36
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Palti R, Horwitz MD, Smith NC, Tonkin MA. Early combined neurosurgery and orthopaedic surgery in Neonatal Brachial Plexus Palsy. Hand Surg 2011; 16:155-159. [PMID: 21548150 DOI: 10.1142/s0218810411005254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 05/30/2023]
Abstract
Three cases are presented in which neurosurgical reconstruction of a Neonatal Brachial Plexus Palsy was combined with orthopaedic reconstruction of a posterior glenohumeral dislocation. The authors believe that a combined procedure is indicated if the neurological deficit meets the criteria for neural reconstruction and the complication of a posterior glenohumeral dislocation has occurred prior to nerve surgery. Two children with C5-6 lesions and a third child with a pan-plexus lesion obtained good shoulder function following the combined reconstruction.
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Affiliation(s)
- Ram Palti
- Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St. Leonards, NSW, Australia
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37
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Klass D, Horwitz MD. Orthopaedic one-stop clinics: feasible or fantasy? Br J Hosp Med (Lond) 2010; 71:248-9. [PMID: 20448490 DOI: 10.12968/hmed.2010.71.5.47902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Horwitz MD, Sorene ED. Bare below the elbows policies: unnecessary bureaucracy. Br J Hosp Med (Lond) 2010; 71:124-5. [PMID: 20220713 DOI: 10.12968/hmed.2010.71.3.46971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A knee-jerk reaction is defined in non-medical terms as ‘an automatic readily predictable response’, while the classical medical definition emphasizes that the outgoing message bypasses the core of the central nervous system. The current bare below the elbows policy, as advocated by the Health Secretary Alan Johnson in September 2007, seems to fit these definitions. It is an ill thought-out and evidence-deficient policy that was more of a response to the popular press than a true solution to the problem of hospital-acquired infections. This editorial looks at some of the key elements in that policy as well as some of the others that should have been included in the original package to tackle hospital-acquired infection.
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39
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MacNamara P, Yam A, Horwitz MD. Biceps muscle trauma at birth with pseudotumour formation: a cause of poor elbow flexion and supination in birth lesions of the brachial plexus. J Bone Joint Surg Br 2009; 91:1086-9. [PMID: 19651840 DOI: 10.1302/0301-620x.91b8.22125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We retrospectively studied the possibility that direct trauma to the biceps muscle might be the cause of poor elbow flexion and supination in 18 consecutive children with birth lesions of the brachial plexus who had delayed or impaired biceps recovery despite neurophysiological evidence of reinnervation. All had good shoulder and hand function at three months of age. Eight recovered a strong biceps after six months, but nine required a pectoralis minor to biceps transfer to augment elbow flexion and supination. One had a delayed but good recovery of the biceps after microsurgical reconstruction of the plexus. All had a clinical 'pseudotumour' in the biceps muscle, which was biopsied during pectoralis minor transfer in two patients and showed rupture and degeneration of muscle fibres with a fibro-fatty infiltrate, suggesting previous muscle trauma. Direct muscle trauma is an uncommon but important cause of delayed or impaired biceps recovery after brachial plexus birth injuries. Surgery to reinnervate the biceps muscle will not work if substantial muscle damage is present when a suitable muscle transfer should be considered.
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Affiliation(s)
- P MacNamara
- Peripheral Nerve Injuries Unit Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA74LP, UK
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Patel VP, Raptis D, Christofi T, Mathew R, Horwitz MD, Eleftheriou K, McGovern PD, Youngman J, Patel JV, Haddad FS. Development of electronic software for the management of trauma patients on the orthopaedic unit. Injury 2009; 40:388-96. [PMID: 19217618 DOI: 10.1016/j.injury.2008.10.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 08/28/2008] [Accepted: 10/02/2008] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Continuity of patient care is an essential prerequisite for the successful running of a trauma surgery service. This is becoming increasingly difficult because of the new working arrangements of junior doctors. Handover is now central to ensure continuity of care following shift change over. The purpose of this study was to compare the quality of information handed over using the traditional ad hoc method of a handover sheet versus a web-based electronic software programme. It was hoped that through improved quality of handover the new system would have a positive impact on clinical care, risk and time management. METHODS Data was prospectively collected and analyzed using the SPSS 14 statistical package. The handover data of 350 patients using a paper-based system was compared to the data of 357 cases using the web-based system. Key data included basic demographic data, responsible surgeon, location of patient, injury site including site, whether fractures were open or closed, concomitant injuries and the treatment plan. A survey was conducted amongst health care providers to assess the impact of the new software. RESULTS With the introduction of the electronic handover system, patients with missing demographic data reduced from 35.1% to 0.8% (p<0.0001) and missing patient location from 18.6% to 3.6% (p<0.0001). Missing consultant information and missing diagnosis dropped from 12.9% to 2.0% (p<0.0001) and from 11.7% to 0.8% (p<0.0001), respectively. The missing information regarding side and anatomical site of the injury was reduced from 31.4% to 0.8% (p<0.0001) and from 13.7% to 1.1% (p<0.0001), respectively. In 96.6% of paper ad hoc handovers it was not stated whether the injury was 'closed' or 'open', whereas in the electronic group this information was evident in all 357 patients (p<0.0001). A treatment plan was included only in 52.3% of paper handovers compared to 94.7% (p<0.0001) of electronic handovers. A survey revealed 96% of members of the trauma team felt an improvement of handover since the introduction of the software, and 94% of members were satisfied with the software. CONCLUSIONS The findings of our study show that the use of web-based electronic software is effective in facilitating and improving the quality of information passed during handover. Structured software also aids in improving work flow amongst the trauma team. We argue that an improvement in the quality of handover is an improvement in clinical practice.
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Affiliation(s)
- Vishal P Patel
- Department of Trauma and Orthopaedics, University College Hospital, London NW1 2PG, United Kingdom.
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Horwitz MD, Awan S, Chatoo MB, Stott DJ, Powles DP. An 8- to 10-year review of the Rotaglide total knee replacement. Int Orthop 2007; 33:111-5. [PMID: 18084758 DOI: 10.1007/s00264-007-0492-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 10/07/2007] [Accepted: 10/08/2007] [Indexed: 11/30/2022]
Abstract
Mobile-bearing knee arthroplasty (MBKA) is an alternative to fixed-bearing knee arthroplasty. This was a retrospective study of the Rotaglide Total Knee System. We present the results of the monitoring of 77 patients (85 knees) with a median duration to failure or end of follow up of 8.5 years (range 0.4 to 10.1 years). Patients were clinically and radiologically assessed at dedicated follow up clinics. The Hospital for Special Surgery (HSS) and Knee Society Score (KSS) systems were used to describe the clinical and radiological findings. The prosthesis had an estimated survival probability of 93.5% (standard error 3.4%) at 9 years. It is associated with good rates of patient satisfaction and high scores on the HSS and KSS systems. No knees were revised for aseptic loosening. This knee replacement has a survival rate equivalent to other prostheses. It is a safe and reliable prosthesis associated with good clinical outcome.
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Affiliation(s)
- M D Horwitz
- Specialist Registrar in Orthopaedics, North West Thames, London Deanery Rotation, 46 Connaught Drive, London, NW11 6BJ, UK.
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Teli M, de Roeck N, Horwitz MD, Horowitz MD, Saifuddin A, Green R, Noordeen H. Radiographic outcome of vertebral bone bruise associated with fracture of the thoracic and lumbar spine in adults. Eur Spine J 2005; 14:541-5. [PMID: 15452704 PMCID: PMC3489230 DOI: 10.1007/s00586-004-0786-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2003] [Revised: 06/28/2004] [Accepted: 07/15/2004] [Indexed: 10/26/2022]
Abstract
Bone bruising associated with long bone injury is a defined entity with known radiological, pathologic and clinical features. Vertebral bone bruise (VBB) has been described through magnetic resonance imaging (MRI) of the injured spine, but to date the consequences of this entity are unknown. The objective of this retrospective study was to describe the plain radiographic outcome of MRI-defined VBB associated with thoracic and lumbar spine fracture in adults, and to assess whether VBBs caused abnormalities of the bone-implant interface at instrumented levels. Levels of VBB were identified through analysis of the full spine MRI in a consecutive series of adult patients admitted to a spinal injuries unit for thoracic and lumbar spine fractures. The anterior wedge angles (AWAs) of thoracic and lumbar vertebrae demonstrating VBB were measured on radiographs taken at time of injury and at follow-up. Abnormalities of the bone--implant interface were recorded at instrumented levels associated with VBB on follow-up radiographs. Thirty VBBs were identified in 18 adult patients who had suffered 21 vertebral fractures. At an average follow-up of 19 months (range, 12--30 months), the mean AWAs of the VBB vertebrae at the time of injury and at the most recent follow-up were 3.5 degrees and 3.8 degrees , respectively (p=0.33, paired t-test). A total of 12 out of 30 (40%) bruised levels were instrumented in 13 out of 18 (72%) operated patients. No bone--implant interface failure was observed at these levels. It is concluded that VBB associated with thoracic and lumbar vertebral fracture in adult patients does not appear to cause significant progressive vertebral deformity or bone--implant interface failure.
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Affiliation(s)
- Marco Teli
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK.
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Abstract
Haemorrhagic complications due to pseudoaneurysms of branch arteries can be treated by selective embolisation. Injuries to the main renal artery cannot be treated in this way without sacrificing the kidney. We report the successful percutaneous treatment of a main renal artery pseudoaneurysm with a stent-graft in a patient with a solitary kidney.
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Affiliation(s)
- M D Horwitz
- Department of Urology, Lister Hospital, Stevenage, Hertfordshire SG1 4AB, UK
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Horwitz MD, Jonas-Obichere M, Holme TC. Hard to swallow. Anaesthesia 2003; 58:600-1. [PMID: 12846633 DOI: 10.1046/j.1365-2044.2003.03207_5.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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