Search

Introduction: Hand injuries are one of the conditions most frequently treated in the Plastic and Reconstructive Surgery Service of the Hospital Central Militar, within the wide variety of these injuries are injuries to the flexor system. Objective: To estimate the incidence, functionality and labor reintegration time in patients with hand flexor system injuries treated at the Hospital Central Militar in the period from March 1, 2020 to March 1, 2022. Methodology: Observational, retrospective, longitudinal, descriptive study in adult patients with injury to the flexor system of the hand, in whom the cause of the injury did not result in complex trauma to the hand. The Strickland and Goglovac functional recovery criteria were used as reference. Results: Despite the fact that flexor zone II lesions in the literature present a worse prognosis for the recovery of normal hand function, the results show that most of the patients are in a good functional scale. Limitations of the study: The study was carried out during the period covered by the COVID pandemic, so that subsequent consultations with longer times and the late start of rehabilitation consultations could have contributed to a poorer recovery of functional recovery. from the patients. [ABSTRACT FROM AUTHOR]

Summary: Flexor tendon entrapment in fractures of the proximal phalanx is a rare occurrence. This complication has only been reported in association with displaced epiphyseal and diaphyseal fractures. Here we describe a case of an unusual proximal phalangeal fracture pattern with functional hindrance of the flexor mechanism. A 34-year-old man presented with an absent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) function of the ring finger 4 weeks after an injury. X-Ray Examination revealed a bony fragment on the radial volar aspect of the proximal phalanx. USS revealed an intact FDS and FDP tendons. Excision of the bony fragment with tenolysis led to restoration of function.

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article describes the clinical case and analyzes the literature concerning endoprosthesis replacement in the case of traumatic thoracic aortic injury in polytrauma. Current strategy of diagnostics and treatment of patient in critical condition with rupture of isthmic aortic part is based on the principle of multistage surgical treatment (damage control orthopedic). The external fixation of multiple pelvis and extremities fractures and on-time implantation of stent-graft in thoracic aortic part were performed at first hours after the admission. A condition of the patient was stabilized. The delayed reconstructive operations on pelvis and extremities bones allowed obtaining the satisfactory functional result. The principles of staged surgical treatment and the use of on-time high-technology methods allowed saving life for the patient even in critical situation in I level traumatologic centre.

The authors consider one of possible variants of surgical treatment of shoulder girdle trauma, which is accompanied by an injury of the main artery. It is based on the application of the principle of staged surgical treatment (damage control orthopedic). The well-timed sufficient diagnostics and treatment of bone-arterial trauma, coordinated work of several surgical teams, the appropriate postoperative management of patients with the using of postponed high-technology intervention allowed obtaining an optimal functional result for extremely severe multitrauma of the chest and limb.

Background. Complete rupture of the flexor hallucis longus tendon in an isolated closed injury is a rare event. The infrequent identification of this injury may be due to a low clinical suspicion of the flexor hallucis longus tendon being a source of pathology in closed foot and ankle injuries. This review will assess the current body of literature and analyse the clinical presentation and current concepts in management of this specific pattern of tendon injury. Method. A systematic literature search was conducted in MEDLINE and Embase to identify relevant publications. Two separate researchers independently reviewed the references identified in the literature search, with each article being assessed against published selection criteria specified in the study protocol registered with PROSPERO. Two reviewers individually examined the raw data presented in each paper that met final inclusion criteria. This data was then presented in the final analysis. Results. There were 10 documented case reports of complete rupture of the flexor hallucis longus tendon in an isolated closed injury reported in the literature. The majority of subjects were male (70%), with an average age of 38 years. The duration of prodromal symptoms ranged from 0-8 months. The most common mechanism of injury was running, seen in 30% of cases. Every documented case in the literature underwent surgical management. Common post-operative outcomes reported were individual joint range of motion and return to prior level of physical activity. Conclusion. Due to the occult nature of the injury and synergistic function of other structures in the foot, delayed presentation of closed flexor hallucis tendon rupture is common. It is unclear from the current body of literature if surgical management of this injury significantly improves patient outcomes. Current evidence from the management of open flexor hallucis longus tendon ruptures suggests that patients can achieve good functional outcomes with non-operative management. Our recommendation would be for initial non-operative treatment of closed flexor hallucis longus tendon ruptures given the potential for acceptable functional outcomes, and to avoid the potential complications associated with operative repair. [ABSTRACT FROM AUTHOR]

Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel’s inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.

Objective: To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture., Methods: A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity ( P >0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score., Results: The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group ( P <0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups ( P >0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant ( P <0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group ( P <0.05)., Conclusion: In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.

This article summarizes the experience of the conservative approach application in closed injuries of parenchymal organs of the abdominal cavity in children. In our clinic 53 patients with closed injuries of the spleen and liver underwent treatment in 2004–2011. The age of patients ranged from 2.5 to 17 years. Spleen injuries detected in 38 patients (71.7 %), liver damages — in 12 patients (22.6 %), concomitant injury of the liver and spleen occurred in 3 cases (5.7 %). Conservative approach was used in 50 patients (94.3 %), it was successful in 47 cases (94.0 %). Sonographic examination enables to identify and determine accurately the origin of the organ injury, and ultrasound monitoring makes it possible to predict the risk for intraabdominal bleeding and to assess the evolution of the initially identified damages in dynamics.

Closed posterior dislocation of the ankle without a fracture is a rare injury. We are reporting a case in a young male on his motorbike, being hit at the right ankle from behind. The mechanisms of injury along with MRI findings are being discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of modified suture technique in the treatment of acute closed Achilles tendon rupture., Methods: Between December 2013 and December 2016, 29 cases with acute closed Achilles tendon rupture were treated with modified suture technique. There were 23 males and 6 females with an average age of 34 years (range, 22-45 years). All patients were sport injuries. The injury located at left side in 22 cases and right side in 7 cases. American Foot and Ankle Surgery Association (AOFAS) ankle and hind foot function score was 44.6±3.6. According to the Amer-Lindholm criteria, 29 cases were rated as poor. MRI showed the complete rupture of the Achilles tendon., Results: The operation time was 35-62 minutes (mean, 46 minutes). The intraoperative blood loss volume was 7-15 mL (mean, 10 mL). The incisions healed by first intention, and no sural nerve injury occured. All patients were followed up 5-38 months (mean, 18.4 months). AOFAS ankle and hind foot function score was 93.1±4.3 at 3 months after operation, showing significant difference when compared with the preoperative value ( t =-49.581, P =0.000). According to the Amer-Lindholm criteria, the results were excellent in 24 cases and good in 5 cases, and the excellent and good rate was 100%; there was significant difference between pre- and post-operation ( Z =-7.294, P =0.000). MRI showed the continuous and integrity of Achilles tendon. No Achilles tendon rupture recurred during the follow-up period., Conclusion: Modified suture technique in the treatment of acute closed Achilles tendon rupture owns the advantages of less trauma, lower recurrence rate of rupture, lower risk of the sural nerve injury, and satisfactory function recovery.

Injury of an artery has a significantly worse prognosis for the patient than a venous injury. Blunt injuries of lower limb digital arteries with the development of acute ischemia present a very rare phenomenon. A crush mechanism with a defect of the non-wetted surface of vessel's inner part and the development of subsequent thromboischemic lesion is essential for the development of ischemia. We report a blunt injury of the right lower limb in a patient after incorrect stepping with subsequent lesion of digital arteries and the development of acute acral ischemia of the right toes.