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Onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Dimitris Rigopoulos, Robert Baran
In patients at risk (immunosuppressive conditions, immunosuppressive therapy, peripheral vascular disease), chemical avulsion is a painless method that has superseded partial surgical avulsion. It may be repeated as often as necessary. Forty percent urea ointment appears to focus its action on the bond between the nail keratin and the diseased nail bed; it spares the normal nail tissue.
Lateral Hernias
Published in Jeff Garner, Dominic Slade, Manual of Complex Abdominal Wall Reconstruction, 2020
A small number of lumbar hernias have been acquired following trauma, usually blunt rather penetrating, in which either the lateral flank muscles are avulsed from the iliac crest (Figure 15.3) or the thoraco-dorsal fascia disrupted (Figure 15.4). These hernias do not emerge through the anatomical lumbar triangles as described earlier. Avulsion injury repair involves re-attaching the muscles to the ileum and this can be extremely difficult because, in the first week after the injury, the muscles may be torn, oedematous and difficult to handle. Tears in the thoraco-dorsal fascia may be easier to repair but such traumatic hernias are often associated with other injuries, so early repair is not a surgical priority. Delayed repair may also be difficult, however, as muscle contractures may prevent re-approximation of the tissues without undue tension.
Hands
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Type I. The FDP tendon ruptures along with both vincula but with no fracture; hence, the tendon retracts into the palm and presents as a tender lump. Early repair (within 10 days) is needed as the vincular and synovial supplies have been disrupted. It is the most severe type of avulsion injury.
A systematic review of surgical intervention in the treatment of hamstring tendon ruptures: current evidence on the impact on patient outcomes
Published in Annals of Medicine, 2022
Aleksi Jokela, Antti Stenroos, Jussi Kosola, Xavier Valle, Lasse Lempainen
Acute avulsions were arbitrarily defined as patients who were operatively treated within 6 weeks after the injury, while chronic avulsions underwent surgery after 6 weeks and analysis was done from studies where comparison was possible [7,13,14,17–21,23,24,31,35] (815 patients, 502 acute and 313 chronic). The mean time from injury to intervention for the acute and chronic groups was 2.8 and 46 weeks, respectively. After repair, 95% of patients acute patients were satisfied with their outcome, which was significantly greater (p < .001) compared to chronic group (77%). Similar finding was noted in return to sports in same level (92% vs. 85%, p < .001). Analysis of variance suggested the effect of time to surgery on return to sport was significant. Weighed mean return to sports was 4.5 months in acute group and 5.6 months in the chronic group (p < .001) No statistically significant differences were found in LEFS (74 vs. 72) at 1 year. Compared with the chronic group, acutely treated patients reported significantly better results (p < .001) in strength testing comparing to the contralateral leg.
Practice patterns for the treatment of acute proximal hamstring ruptures
Published in The Physician and Sportsmedicine, 2020
Nicholas Pasic, J. Robert Giffin, Ryan M. Degen
For diagnosis, surgeons almost unanimously opted for MRI to characterize the injury. Ultrasound was rarely utilized as a part of the diagnostic workup. Recently, a role for ultrasound has been proposed to help identify acute avulsions which would help facilitate expedient diagnosis and urgent surgical treatment [19]. With the increasing prevalence of point-of-care ultrasound in the current medical climate, this could represent a useful adjunct to the initial assessment of these patients in the emergency department. MRI is often preferred to determine the number of tendons involved and degree if tendon retraction. This ultimately impacts surgical planning, as the degree of tendon retraction can affect the surgical approach, the need for sciatic nerve neurolysis, and help anticipate challenges with operative management. This has been demonstrated by Wilson et al. in 2017, whom created a Sciatic Nerve Dissection Scale based on MRI findings to predict a difficult surgical dissection [20].
Equivalent hip stem fixation by Hi-Fatigue G and Palacos R + G bone cement: a randomized radiostereometric controlled trial of 52 patients with 2 years’ follow-up
Published in Acta Orthopaedica, 2019
Peter B Jørgensen, Martin Lamm, Kjeld Søballe, Maiken Stilling
Patients assessed for study participation and follow-up of randomized participants are shown in the CONSORT flowchart (Figure 1). 1 patient was excluded during surgery because the MixiGun jammed twice during application of cement, due to a human error. At 2 years’ follow-up, there have been no revisions due to aseptic implant loosening. 1 patient suffered a traumatic periprosthetic fracture 18 months after operation and received revision of the stem and osteosynthesis of the fracture. 2 patients suffered hip dislocation within the first 3 months, 1 of these combined with avulsion of the greater trochanter. Another patient had avulsion of the greater trochanter post-surgery without known trauma. Both avulsions were treated nonoperatively. There was 1 periprosthetic infection 1 month postoperatively treated with soft tissue debridement and change of acetabular liner and metal head. This patient had a full recovery but died of causes unrelated to the periprosthetic infection 2 months before 2-year follow-up. The clinical scores (OHS and VAS pain) were similar at 1-year follow-up and 2-year follow-up between groups (Figure 2). At 2-year follow-up, VAS pain and OHS correlated neither with subsidence (rho < 0.2) nor with retroversion (rho < 0.01) (Table 2, see Supplementary data).