Science method

Hand Surgery - Science method

All related research in the practice of hand surgery
Questions related to Hand Surgery
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15 y old male normal xrays no other symptoms normal uric acid level bilateral lesions no history of trauma
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As Hartmut Foerstner wrote
most often: Synovialitis of flexor tendons, A1 Pulley affection,
often: infections,
rare: hundreds of diagnoses possible: periarticular crystal arthropathy, some bone tumors (osteoid osteoma) and many many more
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The antimicrobial effect of local anesthetics has been known for more than 50 years, but it still seems to have an unclear mechanism of action. which bacteria? which concentration? etc etc. . Where can I find more literature?
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some anesthetics like procaine and benzocaine have the ability to generate oxidative stress via oxidizing free radicals. Common knowledge about these drugs. - Oxidative stress caused by amino ester anesthetics might be antiseptic toward common skin or mucosa flora just like Oxygen Water (hydrogen peroxide) and thus antimicrobial. Just a thought
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Is there any selective advantage to the brachial plexus being a network instead of independent nerves? Same question for the lumbosacral plexus.
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i have found it is difficult to get clear answers to questions about the original design of the body...
why would the taste sense of the anterior part of the tongue run through the middle ear
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I have to draw the illustrations for the cover of JHS in 2019. In Jan i have Syndactyly, in Feb. the CMC-1 Arthrosis.
What would be a good topic for March, April, May,.....
Are there any suggestions?
Thank you very much!
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What do you think about loge de Guyon anatomy?
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On the Czech Republic there are realised about 13500 surgeires with THA, there are in Central Health Statistic to find about 32 types of typical product set THA from cca 28 various producers ....but there are no statistic about median Patient durabilities implanting in years, there are no evidence about risks by "easy safety implanting with minimum preoperational complications - technical, postoperational infects, anesthesy complication, Crashes of sets by implanting, luxation of implanting in durace 5 month since Hall surgery, there sre no computer testing of efficiency locomotion ability of patients in timing - 1, 3 , 6, 12, 24 month after usrgeries"...ther are no advice to buy the best types of sets THA for Hospital in respects to realtion Costs/durability of perfect patient functional years, able to reoperability, etc". There are no summary evidences about State views, about local views for safety implantation in identified Clinics with yearly implanting about 850 cases of prime iámplanting THA....there are no advice to patient agreement with surgery THA - as well informed about patients risks....there ar no internal software controlling "Non of Hall surgeries THA could be legal beginning - without Clinic preliminary Plan of individual surgery"...there are absency to preference the computer supervised processing of implanting set THA by the well educated firm Videorecording with describeing the most important describeing mandatory activites of Orthopaeds, Radiologists ...by the Technician Requirements of Laws and with respecitng the firm implanting instruments, Firm implanting Measurements, Firm processing to respects the firm assembling technical and functional accuracy and ability......There are no "bands of acceptable tolerances of medical processing activites" with guaraces of Technical Quality, sequential processing...excluded absency or false partial Results step by steps...Immediately with immediastely to solve medical mistakes in time with substitutional supervising and certificated reoperational processing....substitutional controlling rescued medical processing, etc. There are most patients with stroke or Heart infarct in surgery hall or in the one week after surgery set THA, etc. The Orthopaeds - which are engaged 25 years on this fields of useres medica Tasks have no identity views on Patients risk with such standard operation....they habe no similar routine to carefully implanting set THA as it is standard by finished Clinics testing of New Medical Devices with respects Technicians so as Medical Aspects with rational balancies by repeated Medical strategic decision making...there are interrupting Interface between Research and Developement on the One side - and with User praxis in Hospital Clinis in daily medical workfllow on the Second side - despite the Implanting Technician Laws are the same....but adequated controlling supervised Technician similar system - NO! I saw the thousands of Statistic Analyses - which all prefered the Physicians, Ecopnomics aspects strongly - and undertaken the respensibilities to Patients risks and Technician Requirements Laws systematically!  
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@Cuc     I agree entirely with Dr. Zafiropoulos. Human body is not a machine and it is a very difficult  task if ever possible to measure the effects of THA  using mathematical methods. That is why we use the so-called Joint Replacement Registries which give an exact picture of results and complications with different endoprostheses over the years. The most popular one is the Swedish Hip Replacement Registry since 1979. It is actualized almost each year. In this registry you may see that there are about 5 types of THA models which have stood the test of time giving prosthesis survival in over 95% of the cases on a long-term. Meanwhile, I believe there is a Czech Hip Registry too ?     Please, see links below:
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The ICP rises in all circumferential Burn. Which Intra Compartmental measuring device is most Reliable ?
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In addition to the excellent comments above I would like to add that the TBSA size of the burn injury which drives the amount of fluid used for resuscitation should be a variable in the decision making process. A circumferential burn with a small overall injury and lower volume resuscitation will not have the same effect as the same burn in a patient with a large TBSA burn. Usually burns less than 15% TBSA do not require significant IV fluid administration and with limb elevation and observation the patient may not need and escharotomy. I would have a lower threshold for action in a crush injury or electrical injury...
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I am currently working on my thesis and I am looking for more detailed articles about the surgical procedures used in hands and fingers re-plantations.
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Unfortunately the couplers are for veins only, ment to be used for reducing surgical time in larger vessels anastomoses and require an excess length of vessel which is not really available in most replants. There have been several research projects in the 80's trying to address the question you asked such as using lasers instead of sutures, doing continuous as opposed to interrupted sutures, sleeve anastomosis etc. I suggest you look up these studies
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I have few cases that felt ok following the procedure, but few months later have swelling, pain, limited motion and synovitis - there is no apparent infection. 
I operated on some of them - nothing special except synovitis. In a few, the A1 was incompletely released.
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I always do them open and usually will do a synovectomy. Oftentimes, the synovium is inflamed; its removal I believe reduces "recurrence".
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Madelung's deformity is a rare disease of the wrist which affects mainly females during the adolescence growth spurt. Clinical presentation: radial deviation of the hand with prominence of distal end of ulna and a volar subluxation of the carpus. Various techniques for surgical management have been described until now, but still clear evidence to support the use of any single approach is lacking. 
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Epiphysiolysis is only useful when you expect the growth plate is intact and will correct the deficit. In most cases this is not possible. You can correct the deficit much better by correction osteotomy. With computer you can do a mathematical - theoretical correction but in the patient there are so many limiting structures as tendons, nerves, ligaments, vessels, and so on. In most cases the mathematical aim will not be achieved. and a complete anatomical correctionis not possible if there is a deformation in the distal radius and the proximal row.
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What are treatment options to salvage scaphoid with Scaphoid Non-union Advanced Collapse (SNAC) grades 2-3 vs. Four Corner Carpal Fusion (4CF)?
Existing studies are limited. I have CT scan to send for your review or research project.
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This decision is not easy: SNAC wrist stage 2-3 means radio-scaphoidal arthrosis. You can´t reconstruct this area. So you have only two options: wait or resection of the scaphoid. You can wait when there is enough stability. I have seen some scaphoid pseudarthrosis that were present for 50-70 years with a good wrist motion! I decide the "enough"- stability in the lateral X-ray of the wrist. If the lunate is in strong DISI-position, if there are often swellings of the wrist, if the intra-scaphoid hump-back angle is great, there is not enough stability. In case of "enough"-stability and asymptomatic patients I control X-ray after 6 or 12 month and do nothing, in symptomatic older patients I prefer wrist denervation, in symptomatic younger patients I prefer proximal row carpectomy. 
If there is not "enough" stability the scaphoid has to be removed. If the proximal pole of the capitate and the lunate fossa are intact proximal row carpectomy is the best. If lunate fossa is damaged you can use an osteochondral graft from the capitate side of the proximal scaphoid or from the triquetrum for replacement (see my publication on Kienböck´s disease). If there is a lunocapitate-arthrosis only 4-corner arthrodesis is a good solution. 
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Post traumatic chronic symptomatic DRUJ instability not responding to medical conservative treatment
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If there is a symptomatic instability of the DRUJ the first thing we have do ask is: why is the DRUJ unstable? There are a lot of reasons and a lot of different techniques for surgery. 
DRUJ instability - (sometimes combinations of these procedures are necessary)
1) fracture/pseudarthrosis of the styloid process of the ulna --> refixation of the ulnar styloid gives the best results.
2) Rupture of lig. subcruentum --> transosseous (Ulna head) refixation
3) complete ulnar TFCC- avulsion --> Ligament reconstruction (but not the Adams procedure) with free tendon graft and using the intact material of the TFCC (and there its always a lot you can use!)
4) Ulnocarpal ligaments intact --> ulna shortenig osteotomy (not wafer!) could be an option (ulnocarpal ligaments get more strength--> stability, cartilage lesion of the DRUJ runs out of focus)
5) after fracture of the forearm? Angulation in radius or ulna? --> Correction osteotomy of radius or ulna!
6) with DRUJ arthritis:  Sauvé-Kapandji (with ECU-stabilization of the distal ulna stump after Saweizumi) 
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Hi Amirouche,
To answer to your question I quote Pr François MOUTET from Grenoble in a paper of 1993 :
"Si dans cette série aucun patient n'a bénéficié d'un geste chirurgical c'est bien parce qu'aucun d'eux ne présentait d'effet 'corde d'arc' du fléchisseur. Une telle découverte conduirait à une intervention systématique pour la reconstruction de la poulie totalement déchirée ou rompue. En effet il semble tout à fait clair que le tendon montant en avant, la poulie rompue va passer en arrière de lui créant un effet d'incarcération interdisant la cicatrisation en bonne position de la dire poulie [14].
L'incertitude demeure dans de tels cas en ce qui concerne la conservation du niveau de performance du patient et qui est la demande fondamentale de ces sportifs de haut niveau."
Best regards,
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In spite and notwithstanding the fact of its avascularity, the literature states that it should be done.
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There has been a bit of confusion regarding the 1D lesion. Even Mr Palmer himself was not entirely clear about this when I had the opportunity to ask him several years ago. Some have considered this to be a separation between radius and the central portion of the disc and in this situation a repair will likely not succeed due to absence of vascularity. In case the edge of the disc is an unstable flap it may be resected. It the lesion (a "true" 1D) is in fact an avulsion of either of the radio-ulnar ligaments, together with the disc, it should obviously be repaired in most instances.
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We had one patient with camptodactyly of all the 4 fingers of the left hand.
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I need X ray and photo to this case