1050219 手部常被忽略的疾病

http://normallifemyself.blogspot.tw/2014/05/glomustumor_25.htm

Glomus tumor

75%

GANGLION VS GIANT CELL TUMOR

Giant cell tumor

Ganglion

Giant cell tumor Ganglion cyst

GIANT CELL TUMOR

• The second most common tumors in the hand (ganglion cysts are the most common).

• Commonly occur in patients aged 30-50 years (peak incidence in those aged 40-50 years) • The incidence of local recurrence is high (ranging from 9% to 44%).

• Most commonly adjacent to the distal interphalangeal (DIP) joint

INTRODUCTION

• Trigger finger: stenosing tenosynovitis of the thumb or finger flexor tendon • Clinically, symptoms are caused by a tendon nodule which usually locks the flexor tendon at the level of A1 pulley

VARIOUS TREATMENT METHODS •Non-operative treatments: •Extension splinting •NSAID •Steroid injection

If conservative treatment fails….

VARIOUS TREATMENT METHODS •Operative treatments Open release is traditionally performed under a local anesthesia through a small palmar incision Although digital the successful rate was nearly Including nerve injury, infection, 100%, many complications have beenand stiffness, weakness, scar tenderness, reported of the flexor tendons bowstring

PERCUTANEOUS RELEASE • Lorthioir reported good results without complications • Recently, several other studies have also reported favorable results

But incomplete release or the need to convert to open release with this technique varies from 0% to 11%

Volar plate avulsion fracture

4 months later, subluxation of PIP joint with malunion

Volar plate avulsion fracture

Residual subluxation may be seen as a “V� sign on a lateral radiograph and is associated with a poor prognosis

ONDYLAR FRACTURES OF THE PROXIMAL PHALANX

CONDYLAR FRACTURES OF THE PROXIMAL PHALANX

ONDYLAR FRACTURES OF THE PROXIMAL PHALANX

Volar pl

1st ORTHOPEDIC TRAUMA SYMPOSIUM

南區骨科月會 2008-0329

南區骨科月會 2008-0329

南區骨科月會 2008-0329

COMMON MECHANISM OF FAILURE

PREDICTION OF INSTABILITY IN DISTAL RADIAL FRACTURES • Patient age • Metaphyseal comminution • Ulnar variance

The most consistent predictors of radiographic outcome

INTRA-ARTICULAR FRACTURES • Intra-articular • Impaction/axial load •

Pattern varies

• Typically 3 major fragments • Radial styloid - 1 • Dorsal portion of lunate facet – 2 (die punch fragment) • Volar Portion of lunate facet - 3 •

Comminution varies

• Angle of impact • Energy imparted • Quality of bone

Three Column Theory Extra-articular fractures require avoidance of malunion with angulation and shortening. Malalignment results in limitations of movement, changes of load distribution, mid-carpal instability and increased risk of osteoarthritis in the radiocarpal joint.

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