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Fractures of the hand
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Indications for conservative treatment are:extra-articular, non-dislocated transverse or oblique fracturesdislocated fractures that are stable after repositioning. The reposition must remain stable in a plaster splint in ‘intrinsic plus’ position. Prolonged immobilization in any other position may lead to contractures.Non-dislocated stable fractures can sometimes be treated by means of ‘buddy taping’ to the adjacent finger during two to three weeks. However, the intrinsic and extrinsic tendons can cause a secondary dislocation. Therefore position must be checked with X-ray imaging after one week.
Examination of a Child with Cerebral Palsy
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The static examination of muscle length provides details about the evolution of spasticity into contracture. It is important to differentiate these two as the management differs and is more invasive for managing an established contracture. Contracture, unlike spasticity, is not velocity dependent, and the fixed-length phenomenon of the muscle tendon unit should be examined slowly. It is also important to differentiate contracted biarticular and monoarticular muscles (for example, the Silfverskiold test is used to identify isolated gastrocnemius contracture versus gastrocsoleus contracture). A detailed evaluation will be elaborated under individual joint examination.
Retinoids in Keratinization Disorders
Published in Ayse Serap Karadag, Berna Aksoy, Lawrence Charles Parish, Retinoids in Dermatology, 2019
IBIDS (trichothiodystrophy) syndrome is characterized by ichthyosis, brittle hair, impaired intelligence, decreased fertility and short stature. In IBIDS syndrome, application of topical moisturizers and sunscreen creams is recommended. Systemic or topical retinoid therapy and topical keratolytic creams are not effective. Orthopedic and physical therapy interventions should be performed for contracture (31,44,45).
Assessment of spasticity: an overview of systematic reviews
Published in Physical Therapy Reviews, 2022
Saleh M. Aloraini, Emtenan Y. Alyosuf, Lamya I. Aloraini, Mishal M. Aldaihan
A variety of clinical manifestations may appear following an UMNL, These clinical manifestations are generally classified as positive or negative features [1]. Positive features are those not normally present prior to the UMNL, and the negative features are those that are lost following the UMNL [1]. Spasticity is one of the positive features of an UMNL, and should not be confused with other similar positive features such as: spastic dystonia, clonus or contractures [1]. A contracture is a pathological condition manifested by restriction or loss of full active and passive range of motion of the limb; due to mechanical alteration of joint, muscle or surrounding soft tissues [8, 9]. Despite this significant difference between spasticity and contractures, some measures of spasticity are still unable to discriminate between these two clinical phenomena [10, 11].
Pirfenidone as a potential antifibrotic injectable for Dupuytren’s disease
Published in Pharmaceutical Development and Technology, 2022
Suchitra Panigrahi, Amanda Barry, Scott Multner, Gerald B. Kasting, Julio A. Landero Figueroa, Latha Satish, Harshita Kumari
Treatments for DD are only minimally effective. Until now, the treatment mainstay for flexion contractures has been surgical resection (fasciectomy) of the contracted tissue or cords (Davis 2013) with appropriate splinting and hand therapy after surgery. However, this approach has significant risks including damage to digital nerves, blood vessels, and flexor tendons. In addition, it is painful, requires post-operative care, and is associated with high recurrence rates (27–80%) (Rodrigo et al. 1976; Au-Yong et al. 2005). Numerous non-invasive treatment options (Richards 1952; Pittet et al. 1994; Ball et al. 2016) including the administration of intralesional corticosteroids, radiation, and topical creams, yield limited efficacy. More recently, the intranodular injection of collagenase clostridium histolyticum (CCH) and percutaneous needle fasciotomy have been shown to be less invasive techniques (Hurst et al. 2009; van Rijssen et al. 2012; Costas et al. 2017). Approximately 30–50% of patients (Peimer et al. 2015) who received CCH experienced hand swelling, injection site hemorrhage, and pain. Although CCH appears to be a viable non-operative option for DD, contracture recurrence remains an issue (Nayar et al. 2019). Clinically, many of these treatments are still in use with minimal success. Thus, there is an urgent need to develop a local therapy that can mitigate disease progression to contractures and prevent a recurrence.
The Colostomy of Duret for the High Risk Patient
Published in Journal of Investigative Surgery, 2021
Jody C. DiGiacomo, Mark Lehman
Since the earliest pioneering efforts of Heitzer, Pillore, and Duret, the creation of colostomies has become a commonplace procedure integral to trauma and acute care surgery. Fecal diversion via colostomy has even become an integral component of the management of perineal wounds and ischial or sacral decubiti in patients permanently bedridden due to progressive neuromuscular disease, stroke, or spinal cord injury; especially when the wounds are adjacent to the anus or subjected to frequent and repeated fecal soiling due to incontinence. Chronic contractures may also be present, further complicating management. Fecal diversion becomes necessary, but the patients' myriad medical issues make the risk of general anesthesia perilous, with extubation after the procedure unlikely. Minimally invasive approaches have been described, including blowhole colostomy [5,6], laparoscopic colostomy [7,8], trephine colostomy [9], colonoscope-assisted colostomy [10,11], gasless laparoscopy [12], and single port laparoscopic colostomy [13,14]. We describe a simplified technique for loop colostomy based on the techniques of Heitzer and Duret, which can be performed under local anesthesia and intravenous sedation.