Coronavirus Infections ; epidemiology ; prevention & control ; Elective Surgical Procedures ; statistics & numerical data ; Female ; Humans ; Infection Control ; methods ; Infectious Disease Transmission, Patient-to-Professional ; prevention & control ; Male ; Occupational Health ; statistics & numerical data ; Orthopedic Procedures ; methods ; statistics & numerical data ; Outcome Assessment, Health Care ; Pandemics ; prevention & control ; statistics & numerical data ; Patient Safety ; statistics & numerical data ; Pneumonia, Viral ; epidemiology ; prevention & control ; Risk Assessment ; Safety Management ; Singapore ; Wounds and Injuries ; diagnosis ; epidemiology ; surgery

BACKGROUND: The aim of this study was to investigate the relationship between clinical symptoms and cross-sectional area (CSA) of the median nerve at the carpal tunnel inlet before and after open carpal tunnel release (CTR). METHODS: Thirty-two patients (53 hands) that underwent open CTR for idiopathic carpal tunnel syndrome were prospectively enrolled. Median nerve CSA at the carpal tunnel inlet was measured preoperatively and at 2 and 12 weeks after CTR by high resolution ultrasonography. The Boston carpal tunnel questionnaire (BCTQ) was also completed at these times. RESULTS: BCTQ symptom (BCTQ-S) score was significantly improved at 2 weeks postoperatively, but BCTQ function (BCTQ-F) score and CSA were significantly improved at 12 weeks postoperatively. Preoperative CSA was significantly correlated with preoperative BCTQ-S and BCTQ-F scores but was not significantly correlated with postoperative BCTQ scores or postoperative changes in BCTQ scores. Postoperative median nerve CSA was not significantly correlated with postoperative BCTQ-S or BCTQ-F scores, and postoperative changes in median nerve CSA were not significantly correlated with postoperative changes in BCTQ-S or BCTQ-F scores. CONCLUSIONS: The study shows clinical symptoms resolve rapidly after open CTR, but median nerve swelling and clinical function take several months to recover. In addition, preoperative median nerve swelling might predict preoperative severities of clinical symptoms and functional disabilities. However, postoperative reductions in median nerve swelling were not found to reflect postoperative reductions in clinical symptoms or functional disabilities.
Anatomy, Cross-Sectional ; Carpal Tunnel Syndrome/diagnostic imaging/epidemiology/*physiopathology/*surgery ; Female ; Humans ; Male ; Median Nerve/anatomy & histology/physiopathology/*surgery ; Middle Aged ; Orthopedic Procedures/*statistics & numerical data ; Prospective Studies ; Surveys and Questionnaires ; Ultrasonography ; Wrist/surgery

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

BACKGROUND: Symphalangism is a rare congenital difference characterized by ankylosis of interphalangeal (IP) joints of the fingers and toes. In adults, there were several attempts to restore the stiff joints into mobile ones, but these treatment options resulted in poor outcomes and could not be applied to growing children. Here, we report our experiences on surgical treatment for children who had symphalangism of the hand. METHODS: We treated 36 joints in 17 children with symphalangism of the hand using dorsal capsulotomy and collateral ligament release. The diagnoses were based on history, physical examination, and simple radiographs. Affected fingers were classified according to our grading system. Simple compressive dressing was applied using Coban after surgery. Passive range of motion (ROM) exercise was started on day one or 2 postoperative, with the help of a hand therapist and patients' parents. The patients were prescribed passive ROM exercises for at least 2 hours a day over a period of 6 months. RESULTS: A single surgeon operated on 30 proximal IP joints, 3 distal IP joints, and 3 IP joints of the thumb. Twenty six joints were classified as grade I, and 10 as grade II. The ROM of affected joints, which was 7.8 +/- 8.1 (mean +/- SD) degrees preoperatively, increased to 46.8 +/- 18.6 degrees at final follow-up. The final ROM was significantly better in grade I joints, especially when the children had operations at ages 24 months or younger. CONCLUSIONS: Symphalangism of the hand in children, can be restored into a mobile joint by release of the collateral ligament, a dorsal capsulotomy, and postoperative physical therapy.
Age Factors ; Ankylosis/radiography/surgery ; Child ; Child, Preschool ; Female ; Finger Joint/abnormalities/radiography/surgery ; Humans ; Infant ; Joint Diseases/classification/*congenital/radiography/surgery ; Ligaments/surgery ; Male ; Orthopedic Procedures/methods ; Physical Examination ; *Range of Motion, Articular ; Statistics, Nonparametric ; Treatment Outcome

To evaluate the efficacy of operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients by meta-analysis.The literature search was performed in Cochrance Library, Medline, Embase, SinoMed, CNKI, Wanfang data and CQVIP databases for operative and non-operative treatment of three- or four-part proximal humeral fractures in elderly patients, and searches of conference proceedings were also conducted. The data were extracted and a meta-analysis was performed using RevMan 5.3. The outcome measures included Constants score, pain and incidence rates of AVN, reoperation, osteoarthritis, nonunion.Six randomized controlled trials involving 264 patients were included in the meta-analysis. The differences of Constant scores (=0.47, 95%:-4.35-5.28,=0.85), incidence of ANV (=0.56, 95%:0.25-1.24,=0.15), incidence of osteoarthritis (=0.56, 95%:0.19-1.68,=0.30), incidence of nonunion (=0.43, 95%:0.13-1.43,=0.17) between operative group and non-operative group were not statistically significant. Operative treatment was better in pain score (=1.01, 95%:0.12-1.19,=0.03) and had statistically significant higher reoperative rate (=3.97, 95%:1.45-10.92,=0.007).No evidence support that there is difference in Constant score and incidence rate of ANV, osteoarthritis, nonunion between operative and non-operative treatment for three- or four-part proximal humeral fractures in elderly patients. More high quality randomized controlled trials are required to determine which treatment is more efficient.
Aged ; Comparative Effectiveness Research ; Fracture Healing ; Fractures, Multiple ; complications ; therapy ; Fractures, Ununited ; epidemiology ; Humans ; Humerus ; injuries ; surgery ; Orthopedic Procedures ; adverse effects ; methods ; statistics & numerical data ; Osteoarthritis ; epidemiology ; Osteonecrosis ; epidemiology ; Randomized Controlled Trials as Topic ; Reoperation ; statistics & numerical data ; Shoulder Fractures ; complications ; therapy ; Treatment Outcome

PURPOSE: We aimed to evaluate the nationwide incidence and risk factors for symptomatic deep vein thrombosis (DVT) after major lower limb orthopedic surgeries. MATERIALS AND METHODS: The Korean Health Insurance Review and Assessment Service database was used to retrospectively identify International Classification of Disease-10 codes for DVT and operation codes representing hip arthroplasty, knee arthroplasty, and hip fracture surgeries. The age- and gender-adjusted annual incidence of DVT, rates of major lower limb orthopedic surgeries, and the postoperative incidence of DVT according to the surgical procedure were assessed. RESULTS: The age- and gender-adjusted annual incidence of DVT was 70.67 per 100000 persons/year. Compared to patients aged <49 years, the relative risk of DVT was five times higher in patients aged 50-69 and 10 times higher in patients aged >70 years (p<0.001). Females showed a greater relative risk for DVT than males (1.08; p<0.001). The incidence of postoperative DVT, according to the type of surgery, was significantly greater for knee replacement arthroplasty than for other forms of surgery (p<0.002). The relative risk of postoperative DVT was higher in females in knee replacement arthroplasty (1.47) and hip fracture surgery (2.25) groups, although relatively lower in those who underwent hip replacement arthroplasty (0.97). CONCLUSION: Among major lower limb surgeries, advanced age, female gender, and undergoing a knee replacement arthroplasty were found to be risk factors for developing postoperative DVT. These findings further emphasize the need for orthopedic surgeons to consider the development of DVT after surgery in high-risk patients.
Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Infant ; Infant, Newborn ; Leg/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/*adverse effects ; Postoperative Complications/epidemiology/etiology ; Registries/*statistics & numerical data ; Republic of Korea/epidemiology ; Risk Factors ; Venous Thrombosis/*epidemiology/*etiology ; Young Adult