Distal Radius Malunion

Katt, Brian M.; Seigerman, Daniel; Lutsky, Kevin; Beredjiklian, Pedro K.

doi:10.1016/j.jhsa.2020.02.008

Cited by 30 publications

(23 citation statements)

References 40 publications

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“…11 In addition, those with a symptomatic malunion may require a corrective osteotomy, which has a reported complication rate of 50% and is associated with significant morbidity. 12,13 This example demonstrates the potential dilemma in approaching treatment at a time when non-surgical management may be incentivized.…”

Section: Application: Case Examplesmentioning

confidence: 99%

Approaching “Elective” Surgery in the Era of COVID-19

Lockey

Kessler

2021

The Journal of Hand Surgery

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The COVID-19 pandemic created unprecedented challenges for the healthcare system. In order to meet capacity demands, hospitals around the world suspended surgeries deemed to be “elective.” In hand surgery, there are numerous pathologies treated on an elective basis, but a delay or absence of care may result in poorer outcomes. We present here an ethical framework for prioritizing elective surgery during a period of resource scarcity. Instead of using the term elective, we define procedures that can be safely delayed based on three considerations. First, a safe delay is only possible if deferral will not result in permanent injury. Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy. In considering these criteria, three case examples are discussed taking into account individual patient characteristics and the pathophysiology of the condition. This framework design is applicable to ambulatory surgery in any period of crises that may strain resources, but further considerations may be important if an operation requires hospital admission.

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Section: Application: Case Examplesmentioning

confidence: 99%

Approaching “Elective” Surgery in the Era of COVID-19

Lockey

Kessler

2021

The Journal of Hand Surgery

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“…Ayrıca yeni nesil implantlarla tendon irritasyon ve rüptür oranı azalmaktadır. [4] Dorsal yaklaşımla yapılan açık kama düzeltici osteotomisinden sonra 11 olguluk bir seride implant çıkarmayı gerektirecek olgu olmamıştır. [30] Dorsale açılanmalı yanlış kaynamalarda volar yaklaşımla yapılan osteotomilerde volar korteksin devamlılığının sağlanması kemik grefti kullanımı ihtiyacını ortadan kaldırabildiği gibi sabit açılı volar plak ile kolay ve sağlam tespit elde edilebilir.…”

Section: Pozitif Ulnar Varyans Ile Olan Yanlış Kaynamalarunclassified

“…Yanlış kaynamalar her zaman semptomatik değildir ve oluşturduğu semptomlar da deformitenin şiddetiyle uyumlu değildir. [4] Distal radius kırıklarının yanlış kaynamalarında distal radyoulnar eklem (DRUE) anatomisi ve biyomekanik özellikleri değişebilmektedir. Distal radius yanlış kaynamalarında oluşan deformitelerde birden fazla planda zorlayıcı etki genelde beraber bulunmaktadır.…”

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Radius yanlış kaynaması ile birlikte olan distal radyoulnar eklem instabilitesi

Kiliç¹,

Ayan²

2021

TOTBID

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Ulna başı radius distalinde sığ sigmoid çentik ile eklem yapar. Sigmoid çentiğin volar tarafında %80 oranında eklem dışı osteofibrokartilaj dudak vardır. Bu dudak ulnanın palmar translasyonuna karşı destek etkisi oluşturarak stabiliteye katkı sağlar. [5] Sigmoid çentiğin yarıçapı ulna başından daha büyüktür. Distal radyoulnar eklem stabilitesi kemik yapıdan ziyade yumuşak doku ile sağlanmaktadır. Sigmoid çentik ile ulna başı arasındaki maksimum temas %60 ile nötral pozisyonda olmakta, tam pronasyon ve supinasyonda bu oran %10'a düşmektedir. [6] Kemik anatominin DRUE stabilitesine katkısı %30'dur. [7] Distal ulna maksimum pronasyonda 2,8 mm dorsale, maksimum supinasyonda 5,4 mm volare translasyon gerçekleştirir. [8]

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“…Extrapolating this over 12 weeks of lockdown, with increasing patient numbers, leads to a conservative estimate of over 250 in this group. Mal-union can lead to impaired function and pain [6,7]. Even if 20% of them went on to symptomatic mal-union requiring surgery, this equates to fifty correctional osteotomies on top of a strained elective upper limb service.…”

Section: Implications Of Covid Managed Patients For the Futurementioning

confidence: 99%

Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma

Dunkerley

Thelwall

Omiawele

et al. 2020

International Orthopaedics (SICOT)

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Purpose The COVID pandemic has decreased orthopaedic fracture operative intervention and follow-up and increased the use of virtual telemedicine clinics. We assessed the implications of this management on future orthopaedic practice. We also surveyed patient satisfaction of our virtual fracture follow-up clinics. Method We prospectively analysed 154 patients during two weeks of 'lockdown' assessing their management. We surveyed 100 virtual fracture clinic follow-up patients for satisfaction, time off work and travel. Results Forty-nine percent of patients had decisions affected by COVID. Twelve percent of patients were discharged at diagnosis having potentially unstable fractures. These were all upper limb fractures which may go onto mal-union. Twenty-nine percent of patients were discharged who would have normally had clinal or radiological follow-up. No patients had any long-term union follow-up. Virtual telemedicine clinics have been incredibly successful. The average satisfaction was 4.8/5. In only 6% of cases, the clinician felt a further face-to-face evaluation was required. Eighty-nine percent of patients would have chosen virtual followup under normal conditions. Conclusion Lessons for the future include potentially large numbers of upper limb mal-unions which may be symptomatic. The non-union rate is likely to be the same, but these patients are unknown due to lack of late imaging. Telemedicine certainly has a role in future orthopaedic management as it is well tolerated and efficient and provides economic and environmental benefits to both clinicians and patients.

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Distal Radius Malunion

Cited by 30 publications

References 40 publications

Approaching “Elective” Surgery in the Era of COVID-19

Approaching “Elective” Surgery in the Era of COVID-19

Radius yanlış kaynaması ile birlikte olan distal radyoulnar eklem instabilitesi

Patient care modifications and hospital regulations during the COVID-19 crisis created inequality and functional hazard for patients with orthopaedic trauma

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