Brodie's abscess of the distal radius: an unusual complication after percutaneous pinning.
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ABSTRACT:
SUBMITTER: Johnson JW
PROVIDER: S-EPMC2584216 | biostudies-other | 2008 Dec
REPOSITORIES: biostudies-other
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Project description:This article describes a modified technique that combines percutaneous pinning and casting. A prospective study was conducted on 54 patients with distal radius fracture who were treated with percutaneous Kirschner wire (K-wire) fixation and pin-in-plaster technique. The surgical indications of this technique included displaced extra-articular fracture, intra-articular fracture without significant comminution, and articular step-off less than 2 mm. The average radial height was 10.96 mm, and the volar tilt was 3.97 degrees on immediate postoperative radiographs. Upon removal of pin-in-plaster and percutaneous K-wires, the average radial height was 9.92 mm, and the volar tilt was 3.93 degrees . Bony union was achieved in all patients; the satisfaction rate was 90.7%. Pin-in-plaster technique is effective for maintaining reduction during bone healing. The procedure provides the ability to achieve anatomic reduction and then maintains this reduction through an adequate method of immobilization.
| S-EPMC2525874 | biostudies-other
Project description: Not available
| S-EPMC7007181 | biostudies-literature
Project description:BackgroundPercutaneous pinning fixation (PCP) has been used for the treatment of distal radius fractures for decades, especially in the elderly with fragile soft tissue. However, achieving and maintaining a sound anatomic reduction before PCP is difficult if we use the manipulative reduction method alone. Our study innovatively applied the Steinmann pin retractor for closed reduction combined with PCP, to provide a new protocol for the treatment of distal radius fractures.MethodsFrom March 2017 to July 2018, 49 patients out of 57 that met the inclusion criteria but not the exclusion criteria were included in our retrospective cohort study. Sixteen patients were treated with Steinmann pin retractor-assisted closed reduction combined with PCP (S-PCP), and 19 patients were treated with the manipulative reduction combined with PCP (M-PCP), and 14 patients were treated with the manipulative reduction combined with cast splint (M-C). All these patients received a positive postoperative radiological and clinical evaluation.ResultsAll the patients were followed up for a minimum of 2 years. The radiological parameters in each group improved significantly postoperative (posttreatment). In the S-PCP group, the values of radial height (postoperative, 13.33±1.74 mm; the first follow-up, 13.27±1.81mm; last follow-up, 13.16±1.76mm) and ulnar variance (postoperative, -0.10±1.29mm; the first follow-up, -0.05±1.27mm; last follow-up, -0.12±1.09mm) significantly improved as compared to the M-PCP and M-C groups. While the patients in the M-C group experienced significant re-displacement at the first and last follow-ups, in the S-PCP group, the range of wrist motion including extension (89.94±5.21%), radial deviation (90.69±6.01%), and supination (90.25±5.87%); ulnar deviation (89.81±5.82%) and QuickDASH score (2.70±3.64); and grip strength (92.50±5.59%), pronation (90.50±6.04%), and modified Mayo wrist score (90.94±4.17, the excellent rate reached up to 75%) also improved as compared to the M-PCP group, M-C group, or both groups at the last follow-up.ConclusionS-PCP improves fracture reduction and wrist function and can serve as an effective method for A2(AO/OTA) and A3 type of distal radius fractures in the elderly with limited dorsal comminution, including intra-articular fractures with displacement less than 2mm.
| S-EPMC8235814 | biostudies-literature
Project description:Infectious complications related to retained temporary epicardial pacing wires are rare. We report a case of a focal retroaortic abscess in association with retained pacing wires that became manifest 3 years after surgery for tricuspid valve endocarditis.
| S-EPMC3548537 | biostudies-literature
Project description:Introduction Suppurative otitis media is still the most common ear disease in developing countries. Otogenic complications of this disease have decreased considerably because of the advent of antibiotics, and few rare complications have been encountered. Objective To report a case of a patient with scapular abscess and lumber cellulitis that had progressed from Bezold abscess as a complication of squamous-type chronic suppurative otitis media. Resumed Report A 14-year-old girl presented with foul-smelling, purulent, left ear discharge of 1-year duration and decreased hearing on same ear of 6-month duration. She developed painful swelling in left side of neck with restricted neck movement and high-grade fever of 3-day duration and swelling over the left scapular area of 1-day duration. The examination and investigation diagnosed squamous-type chronic suppurative otitis media with Bezold abscess progressing to scapular abscess and lumber cellulitis. Final Comment Chronic suppurative otitis media can lead to abscess in any part of body.
| S-EPMC4296981 | biostudies-other
Project description:BackgroundInfective complications following percutaneous renal biopsy are rare, even among immunocompromised. However it is important to be vigilant about such complications, to detect them early and prevent morbidity and mortality. We report a case of retroperitoneal abscess with extension to subcutaneous plane after a renal biopsy.Case presentationA 42-year-old female with long standing cutaneous lupus underwent renal biopsy for evaluation of nephrotic range proteinuria. She was on high dose prednisolone complicated with steroid induced hyperglycaemia. Eight weeks after the biopsy she presented with left flank pain, malaise and fever. There was a tender subcutaneous induration over the biopsy site. Contrast CT abdomen showed a retroperitoneal abscess with subcutaneous extension along the path of the biopsy needle. This was successfully treated with surgical drainage and broad-spectrum antibiotics.ConclusionsInfections and abscess formation are rare but serious complications of renal biopsy. Immunocompromised state is a potential risk factor. Possible mechanisms and measures for prevention and early detection of this rare complication are discussed.
| S-EPMC6230226 | biostudies-literature
Project description:BackgroundDistal radius fractures are common, costly, and increasing in incidence. Percutaneous K-wire fixation and volar locking plates are two of the most commonly used surgical treatments for unstable dorsally displaced distal radius fractures. However, there is uncertainty regarding which of these treatments is superior.Questions/purposesWe performed a meta-analysis of randomized controlled trials to determine whether patients treated with volar locking plates (1) achieved better function (2) attained better wrist motion, (3) had better radiographic outcomes, and (4) had fewer complications develop than did patients treated with K-wires for dorsally displaced distal radius fractures.MethodsWe performed a comprehensive search of MEDLINE (inception to 2014, October Week 2), EMBASE (inception to 2014, Week 42), and the Cochrane Central Register of Controlled Trials to identify relevant randomized controlled trials; we supplemented these searches with manual searches. We included studies of extraarticular and intraarticular distal radius fractures. Adjunctive external fixation was acceptable as long as the intent was to use only K-wires where possible and external fixation was used in less than 25% of the procedures. We considered a difference in the DASH scores of 10 as the minimal clinically important difference. We performed quality assessment with the Cochrane Risk of Bias tool and evaluated the strength of recommendations using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. Seven randomized trials with a total of 875 participants were included in the meta-analysis.ResultsPatients treated with volar locking plates had slightly better function than did patients treated with K-wires as measured by their DASH scores at 3 months (mean difference [MD], 7.5; 95% CI, 4.4-10.6; p < 0.001) and 12 months (MD, 3.8; 95% CI, 1.2-6.3; p = 0.004). Neither of these differences exceeded the a priori-determined threshold for clinical importance (10 points). There was a small early advantage in flexion and supination in the volar locking plate group (3.7° [95% CI, 0.3°-7.1°; p = 0.04] and 4.1° [95% CI, 0.6°-7.6°; p = 0.02] greater, respectively) at 3 months, but not at later followups (6 or 12 months). There were no differences in radiographic outcomes (volar tilt, radial inclination, and radial height) between the two interventions. Superficial wound infection was more common in patients treated with K-wires (8.2% versus 3.2%; RR = 2.6; p = 0.001), but otherwise no difference in complication rates was found.ConclusionsDespite the small number of studies and the limitations inherent in a meta-analysis, we found that volar locking plates show better DASH scores at 3- and 12-month followups compared with K-wires for displaced distal radius fractures in adults; however, these differences were small and unlikely to be clinically important. Further research is required to better delineate if there are specific radiographic, injury, or patient characteristics that may benefit from volar locking plates in the short term and whether there are any differences in long-term outcomes and complications.Level of evidenceLevel I, therapeutic study.
| S-EPMC4523532 | biostudies-literature
Project description:Background and purpose - The reliability of conventional radiography when classifying distal radius fractures (DRF) is fair to moderate. We investigated whether reliability increases when additional computed tomography scans (CT) are used. Patients and methods - In this prospective study, we performed pre- and postreduction posterior-anterior and lateral radiographs of 51 patients presenting with a displaced DRF. The case was included when there was a (questionable) indication for surgical treatment and an additional CT was conducted within 5 days. 4 observers assessed the cases using the Frykman, Fernández, Universal, and AO classification systems. The first 2 assessments were performed using conventional radiography alone; the following 2 assessments were performed with an additional CT. We used the intraclass correlation coefficient (ICC) to evaluate reliability. The CT was used as a reference standard to determine the accuracy. Results - The intraobserver ICC for conventional radiography alone versus radiography and an additional CT was: Frykman 0.57 vs. 0.51; Fernández 0.53 vs. 0.66; Universal 0.57 vs. 0.64; AO 0.59 vs. 0.71. The interobserver ICC was: Frykman: 0.45 vs. 0.28; Fernández: 0.38 vs. 0.44; Universal: 0.32 vs. 0.43; AO: 0.46 vs. 0.40. Interpretation - The intraobserver reliability of the classification systems was fair but improved when an additional CT was used, except for the Frykman classification. The interobserver reliability ranged from poor to fair and did not improve when using an additional CT. Additional CT scanning has implications for the accuracy of scoring the fracture types, especially for simple fracture types.
| S-EPMC5694815 | biostudies-literature
Project description:IntroductionGiant cell tumor of bone (GCTB) is a benign-aggressive tumor that has a high-rate of recurrence with curettage resection alone. Patients with GCTB in underserved regions of the world can have progression of the tumor with significant disability due to a lack of specialty care. We present a case of an en bloc resection of an aggressive, recurrent GCTB of the radius with excellent function and no evidence of tumor recurrence two years after surgery.Presentation of caseA 22-year-old right-hand dominant female in Haiti developed an aggressive recurrence of a giant cell tumor of bone (GCTB) of the distal radius. Treatment consisted of en bloc resection of the distal radius with the proximal row of the carpus and centralization of the ulna. At two-year follow-up, the patient maintained good functional capacity with no clinical or radiological evidence of recurrence.DiscussionGCTB can cause significant destruction of the bone and articular surface if not treated adequately. Treatment options should be considered carefully in underserved regions of the world based on the resources available. This case exemplifies that complex limb-salvage surgery is possible when coordination of care between international and local surgeons is provided with an emphasis on continuity of care post-operatively.ConclusionEn bloc resection with centralization of the ulna remains a viable technique to address aggressive GCTB of the distal radius and can be appropriate in resource-limited settings.
| S-EPMC7921517 | biostudies-literature
Project description:INTRODUCTION: We retrospectively compared the outcomes of open reduction and internal fixation (ORIF) with volar locking plate versus standard external fixation and percutaneous pinning in treating similar unstable distal radius fractures with a minimum 2-year follow-up. METHODS: The ORIF group included 41 patients with an average follow-up of 29 months. The external fixation group comprised 14 patients with an average follow-up of 33 months. Average age at presentation was 45 years in the external fixation group and 48 years in the ORIF group. The male/female ratios were 16:25 among the ORIF group and 6:8 in the external fixation group. The two groups were compared for clinical and functional outcomes measured by the disabilities of the arm, shoulder, and hand (DASH) score. Pain scores were similar. Radiographic measurements were also evaluated between groups. RESULTS: Final ranges of motion and grip strengths were similar between the two groups. The mean DASH score of the locked volar plate group was 9 compared to 23 for the external fixation group. Radiographically, volar tilt and radial length were significantly better in the patients treated with ORIF. The ORIF group required less therapy visits. No complications occurred in the locked volar plate group whereas two patients had pin tract infections and one had prolonged finger stiffness in the external fixation group. CONCLUSION: Locked volar plating compares favorably to external fixation and pinning for amenable fracture patterns. Whereas grip and range-of-motion data were similar, DASH scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF.
| S-EPMC2529138 | biostudies-other