1/21. A study of post-traumatic shingles as a work related injury.BACKGROUND: After chicken pox, the herpes varicella-zoster (HVZ) virus may remain dormant in the dorsal root ganglion until later reactivation causes shingles, characterized by painful dysesthesias and cutaneous vesicular eruptions along a unilateral dermatome. Shingles as a work-related injury has not been previously addressed in the medical literature. Case history We present a 50-year old female hospital employee who, while working, sustained an acute, traumatic hyperextension injury to her right wrist, hand, and fingers. Although she initially responded to treatment for flexor tendinitis, she suddenly developed shingles in the right C5-C6 dermatomes. She was treated with famcyclovir and her skin lesions resolved, but post-herpetic neuralgia persisted. CONCLUSIONS: It was felt that her shingles was causally related to her occupational injury since trauma (previously reported to precipitate shingles) was her only risk factor and the timing and location of the lesions corresponded closely to the occupational injury. In addition to appropriately diagnosing and treating their patients, workers' compensation physicians often must determine if a particular condition was caused by the original work-related incident. Clinicians who treat trauma patients and injured workers should be aware of post-traumatic shingles and understand the causal relationship of this uncommon but clinically important phenomenon.- - - - - - - - - - ranking = 1keywords = post-traumatic (Clic here for more details about this article) |
2/21. Early wrist arthrodesis for irreparable intra-articular distal radial fractures.When articular restoration and congruity cannot be accomplished in distal radial fractures owing to severe articular bone loss or comminution, early wrist arthrodesis should be considered. This procedure rapidly restores wrist alignment and stability and controls pain. arthrodesis is a highly reliable and definitive procedure that optimises the opportunity for early functional and occupational recovery while minimising the risks of developing stiff digits or chronic pain in injuries otherwise doomed from the start of treatment to result in severe wrist stiffness and post-traumatic arthritis. Simultaneous proximal row carpectomy or the use of ipsilateral local bone graft donor sites, such as the distal radius or proximal ulna, decrease both initial treatment and hospital costs and morbidity. wrist arthrodesis is also effective when polytrauma or multiple fractures co-exist. Successful early treatment may expedite return to work and reduce lost time and wages resulting from the injury.- - - - - - - - - - ranking = 0.2keywords = post-traumatic (Clic here for more details about this article) |
3/21. Traumatic disruption of a fibrocartilage lunate-triquetral coalition--a case report and review of the literature.Whilst osseous coalitions of the lunate and the triquetrum are known to be asymptomatic, fibrocartilage lunate-triquetral coalitions can present an uncommon cause for ulnar-sided wrist pain. To diagnose this condition a high degree of suspicion is needed. We present a case with painful post-traumatic disruption of a fibrocartilage lunate-triquetral coalition that was primary misdiagnosed to be a disruption of the interosseous lunotriquetral ligament and was initially treated arthroscopically. Persistent symptoms lead to X-ray examination of the opposite wrist, revealing a complete osseous lunate-triquetral coalition. CT and MRI investigations demonstrated the fibrocartilage coalition of the affected wrist. Subsequently, lunotriquetral fusion using a cannulated Herbert screw was performed and settled the symptoms completely.- - - - - - - - - - ranking = 0.2keywords = post-traumatic (Clic here for more details about this article) |
4/21. Dislocation of the pisiform bone after severe crush injury to the hand.The pisiform bone dislocated in a 56-year-old worker who had a crush injury of his wrist. Open reduction and reconstruction of the ligaments resulted in proximal subluxation of the pisiform bone and post-traumatic arthritic changes. Other authors recommend that excision of the pisiform is considered to be a more appropriate method of treatment.- - - - - - - - - - ranking = 0.2keywords = post-traumatic (Clic here for more details about this article) |
5/21. Dorsal transscaphoid-transtriquetral perilunate dislocation in pseudarthrosis of the scaphoid.A patient reported that he sustained a minor fall on the outstretched hand in hyperextension, pronation, and in ulnar deviation. Initial radiographs suggested dorsal transscaphoid-transtriquetral perilunate dislocation. Traditionally, however, this injury is the result of a high-energy impact. A CT scan obtained after closed reduction of the dislocation revealed not only a fresh fracture of the triquetrum but also two corticalized fragments of the scaphoid. A former major fall on this hand and a normal scaphoid of the other hand made pseudarthrosis more likely than scaphoid bipartition. arthrography revealed intact lunotriquetral and scapholunate ligaments, precluding the possibility of preexisting ligamentous instability. pseudarthrosis of the scaphoid with a loss of scaphoid function as a mechanical tie-rod of the carpus is most likely responsible for this complex injury. This is the first clinical study that shows that single scaphoid discontinuity without preexisting ligamentous carpal instability may lead to complex perilunar dislocation in minor trauma.- - - - - - - - - - ranking = 0.00016093423300683keywords = impact (Clic here for more details about this article) |
6/21. Unusual cause of wrist pain in a golfer.wrist injury is common in golfers and normally occurs at the impact of the club with the ball. The unusual case is reported of a low handicap golfer with wrist pain aggravated by the putting stroke. The condition was resolved with treatment. The likely mechanism for the injury is discussed.- - - - - - - - - - ranking = 0.00016093423300683keywords = impact (Clic here for more details about this article) |
7/21. Early proximal row carpectomy after severe carpal trauma.Complex fracture dislocations of the wrist often result in post-traumatic arthrosis. In these cases, patients can experience severe pain and loss of function of the wrist and as a result many of them end up having a total arthrodesis. In trying to avoid the disadvantages of a total arthrodesis, alternative treatment strategies have been investigated, amongst which proximal row carpectomy (PRC). Basic conditions for a good outcome of PRC are an intact cartilage of the lunate fossa of the distal radius and an intact surface of the head of the capitate for the new radiocapitate joint (, schematic drawing post-PRC). Also, an intact (volar) radioscaphocapitate (RSC) ligament is necessary because it plays an essential role in stabilizing the new joint and preventing volar dislocation and ulnar translocation of the distal carpal row. Acute post-traumatic PRC can be indicated, but is rarely reported in literature. In this article, we present four patients whom we have treated with early PRC after severe trauma of the wrist. Three patients had a good outcome. In the patient with the bad outcome, the before-mentioned prerequisites were not met, which is discussed.- - - - - - - - - - ranking = 0.4keywords = post-traumatic (Clic here for more details about this article) |
8/21. Irreducible chronic palmar dislocation of the distal radioulnar joint--a case report.We report a rare case of irreducible chronic palmar dislocation of the distal radioulnar joint (DRUJ). This case showed that the dislocated ulnar head was impacted to the palmar cortex of the radius probably due to the dynamic force of the pronator quadratus muscle. Re-attachment of the ulnar styloid and partial resection of the ulnar head were necessary to make the reduction of the DRUJ possible. The continuity of the radioulnar ligament to the ulnar head was restored and the stability of DRUJ was maintained after reduction.- - - - - - - - - - ranking = 0.00016093423300683keywords = impact (Clic here for more details about this article) |
9/21. Isolated intra-articular fracture of the distal ulna: a rare injury related to airbag deployment.An isolated intra-articular and adjacent shaft fracture of the distal ulna is described. A 38-old-year woman driver sustained an automobile accident with subsequent airbag deployment injuring her left wrist. Imaging studies showed displacement of a radiovolar fragment and deformity of the ulnar articular surface. The fracture was reduced and internally fixed with 3, 3.5-mm, cannulated screws to avoid future difficulties in forearm rotation, ulnocarpal impaction, and late posttraumatic arthritis. The final outcome was excellent. Careful clinical and radiologic examination is strongly recommended for this type of fracture, which seems to be a part of the spectrum of upper limb injuries associated with airbag deployment. Such injuries can be expected to occur more frequently with the increasing use of airbags.- - - - - - - - - - ranking = 0.00016093423300683keywords = impact (Clic here for more details about this article) |
10/21. Palmar radiocarpal dislocation resulting in ulnar radiocarpal translocation and multidirectional instability.Posttraumatic ulnar radiocarpal translation is a rare, often subtle, highly unstable, and potentially devastating manifestation of severe "proximal radiocarpal ligamentous instability. Radiocarpal dislocation should alert the treating physician to the risks of the spectrum of radiocarpal instabilities. Radiocarpal instability may initially be masked or unappreciated owing to presentation without radiocarpal dislocation, local pain and swelling, initially normal standard wrist radiographs, lack of recognition, or delay in the appearance of a static lesion. The specificity, sequence, and extent of extrinsic radiocarpal and ulnocarpal ligament traumatic disruptions are not fully understood, vary with injury severity, and may differ in instances of dorsal as opposed to palmar subluxation or dislocation. Multidirectional (global) wrist instability typically accompanies this ulnar radiocarpal instability in its most severe form and consequences may be dire. The carpus may be difficult to reduce or maintain owing to marked instability, compressive forces across the wrist, and soft tissue or bony fragment interposition. Additional local distal radioulnar joint or intercarpal injuries may further confound stability and require their own specific and simultaneous treatment. Radiocarpal reduction and repair of the radioscaphocapitate ligament and radiolunate ligaments may be sufficient treatment for acute isolated palmar radiocarpal instability. Temporary K-wire fixation may be added as a precaution to prevent palmar carpal subluxation during the time of ligament healing. Radiocarpal reduction, palmar and dorsal soft-tissue repair, and temporary K-wire fixation comprise one method of treatment for early recognized cases of post-traumatic ligamentous ulnar radiocarpal transposition. Halikis et al have recommended radiolunate arthrodesis. Rayhack et al have suggested that limited or complete wrist arthrodesis may be indicated for patients with delayed presentation or in acute cases with extreme instability. wrist arthrodesis is one means of management for patients with severe radiocarpal instability confounded by distal radioulnar joint or intercarpal instability, as seen in our patient. Damaged ligaments may have a poor blood supply and often may not hold sutures or heal well. Bone anchor sutures or some type of ligament augmentation may help to restore joint stability in some patients. Loss of stability may occur later owing to ligamentous laxity or inadequate soft-tissue healing. Radiolunate, radiocarpal, or complete wrist arthrodesis may be necessary to relieve pain, restore wrist alignment and stability, and reestablish extremity function for patients with chronic radiocarpal instability. wrist symptoms, age, general health, hand dominance, and occupation may be among the factors that influence the necessity for and timing of reconstruction. Rayhack et al have also postulated that negative ulnar variance may accommodate the occurrence of ulnar radiocarpal translocation and confound repair owing to lack of buttress at the ulnocarpal joint. They further speculated that a joint leveling procedure might improve the support for ligamentous repair or reconstruction in these cases. Permanent functional impairment must be anticipated in patients with ulnar radiocarpal instability. Impairment has typically been commensurate with the extent of the initial lesion, additional confounding local lesions, and length of follow-up.- - - - - - - - - - ranking = 0.2keywords = post-traumatic (Clic here for more details about this article) |
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