This case report describes a young patient who presented with two irreducible dislocations - a dorsal compound complex dislocation of the right index finger metacarpophalangeal joint associated with fractures, and an irreducible closed dorsal dislocation of the left little finger metacarpophalangeal joint. The dislocations were successfully reduced through open reduction surgery using a volar approach and Kirschner wires, which were removed four weeks later. The patient recovered full range of motion in both fingers.
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
Shoulder dislocations are the most common joint dislocations, and only 2% of these are seen as posterior shoulder dislocations. The floating elbow was first described in children, after that shown in adults. Floating elbow cases are very rare, and usually seen with high-energy trauma. Classical definition is the coexistence of the humeral diaphyseal and forearm fracture, but there are other definitions as well.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Appendicitis was first recognized as a disease entity in the 16th century and was called perityphlitis. McBurney first described its clinical findings in 1889.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Percutaneous fixation of bilateral anterior column acetabular fractures: A ca...Apollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
There are clinical situations where open reduction is either
not feasible (due to associated medical problems) or when the fractures are not significantly displaced, then minimal invasive means of internal fixation of these fractures seems to be an attractive option. Percutaneous screw fixation of the anterior column of the acetabulum has been a challenging task because of its unique anatomy (narrow corridor of bone) and risk of intra-articular penetration.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Appendicitis was first recognized as a disease entity in the 16th century and was called perityphlitis. McBurney first described its clinical findings in 1889.
Percutaneous fixation of bilateral anterior column acetabular fracturesApollo Hospitals
The treatment of displaced acetabular fractures with open
reduction and internal fixation has gained general acceptance. This is done either by anterior, posterior or combined approaches depending on the location of these fractures. These procedures may be associated with various complications like significant blood loss, infection, lengthy operative times, heterotopic ossification and neurovascular complications.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Dorsal lrreducible Compound Complex Fracture dislocation of the index finger.pdf
1. -
CASE REPORTS
DORSAL IRREDUCIBLE COMPOUND COMPLEX
DISLOCATION OF THE METACARPOPHAI-ANGEAL JOINT
OF THE INDEX WITH A CLOSED IRREDUCIBLE
DISLOCATION IN THE CONTRAI-ATERAL LFTLE FINGER.
A Case Report and Literature Review.
Freih Abu Hassan A, Shaher El-Haddidy.
ABSiTRACT
A young patient had a Dorsal lrreducible Compound Complex
Fracture aiAocatidn of the index finger, with an epiphyseal iniury ot the head
of the third metacarpat bone tqether , togather with green stick tracture of
the distal radial and ulnar metaphyseal region. This was associated with an
irreducibta ctosed complex do(al dislocation of the little tinger in the
nntralateral hand.
The patient presented a month late, the dislocation were suwssfully
reduced by'open rbduction using the volar qproach, and maintained by
Krdtner Wires, which were removed tour weel<s later.
INTRODUCTION
Reports of the complex dislocations of the
metacarpophalangeal joints are not common, but fracture dislocations
are rar-e.
'The
compound element with a late presentation makes
this entity rather u"ry r"r"(
1' 3
'
4' 6' 10' 12' 13' 14' 15'20'23'24'25)'
The mechanism of iniury ol the complex dislocation is forced
hyperextension of the proximal phalanx in a fall on the hand which results in
pushing the metacarpal head through the volar Joint capsule
( 20 ).
The lrreducibility of the dislocations were attributed to many factors :
1. Wedging of the fibrocartilagenous volar plate within the ioint
( 3't+'16'20 ).
2.Trapping of the Metacarpal head by the palmar fascia and the transverse
metacarpal ligament
( 3
'20 )
3. Displaced flexor tendons which becomes dorsal to the metacarpal
tread(3'20).
Correepondence should bo addreeeed to :
Dr. Freih Abu Hassan, Jordan University Hospitaf, Amman, Jordan.
-199-
2. a
a
JORDAN MEDICAL JOURNAL voL. 26 NO. 2.NOV.1992
Also there are rare caus€s ol obstruction, such as :
a. The dorsal aponeurosis
( 1 ) .
b. A pinched sesamoid bone in children above 10 yesrs
( 22 ).
This type ol dislocarion
( 20 ) is diagnosed as the lollowing ground :
t. Ciinic*ty - Shofi, ulnar deviation and rotation of the finger.
- Semi flexed finger in proximal and distal interphalangealjoints.
- No movement ol the dislocated joint can be elicited.
- The rnetacarpal head can be palpated just beneath the distal part ot
the palm.
- Dimpling of lhe palmar skin is usually observed.
ll. Radiologically (anterio - postedor, lateral, and oblique films ) :
- Dorsal and ulnar dislocation of the base of the proximal phalanx.
- Wderpd space between the metacarpal heads
( second and thkd in cases of index finger ) ,
( fourth and fifth in cases of llttle lingor ).
Gaee Repon
An eleven-year-old male student was admitted to the hospital as a
case of fallen down from about three meters height. The patient was
diagnosed to have the following prcblems :
1) Head injury manifested by : Semiconsciousness , bleeding lrom both
nostrils., dilated & fixed left pupil, haematoma over the lett forehead and
Glasgow coma scale reoorded as 10/15.
2l Abdominal injury were manifested by : Guarding and rigtdity of the
abdomen. The peritoneocentesis revealed frank blood.
3) Deep cul wound, about two centimeter over the volar aspect of the
metacarpophalangealjoint ol the right index linger.
lmmediate surgery was done : He undenrent splenectomy for splenic
injury. Three bun holes were performed on the lett side and were negative,
he also had debridement and closure of the cut wound ol the right palm. The
patielt recovered well and was transferred to the lcU. He was mecfranically
-ventilated for 48 hours , then he stayed for five days in the normal ward.
The patient discharged home on the seventh post operative day to be seen in
the outpatient Department,
-200-
3. DORSAL IRREDUCI BLE DISLOCATION
JOINT OF INDEX IN LITTLE FING.ER.
F.ABU HASSAN & S.EL-HADIDY
After two weeks of discharge the patient was transfened to the hand
service complaining of p"in and d6formity of both hands. On examination :
the patient haO upper-ielpi;;t"ty ttact intei,tion whicfr added another week of
delay in management. ifie rign[ nand and forearm showed delormity of the
tnJ"i fing"t in-tne torm oiHyperextensjg.n of the metacarpophalangeal jopt'
i6iaiion
-or the fingei ou"'iine mioote tinger, no moJement ol the
metacarpopnaangeiiioint, shortening and ulnar ward deviation of the finger'
"""ibf
'pr6viousti
ruirr"O cut wouid over the.palm, complex irreducible
ii["r'rld"ture oistocatf; ;i the metacarpoptialangeal- ioint ol the index
f Fig. z, 3 ), salter and Hanis type il epiphyseal fractures_of the middle finger
l""i""irpii head ( Fig, t, i').anO'g.t;"n stick fractures in the distal
6;iillfiG ;l-botti radjus inO irlna wiih minimal displacement and good
callusformation (Fig. 1' 2 ) .
l
{
i
1
Figure ( 1
Figure ( 2 |
,201-
4. -l
i
.l
'.i I
I
I
I
I
JORDAN MEDICAL JOURNAL voL. 26 NO. 2.NOV.1e92
Also, examination of the lett hand revealed a deformity of the little linger in
the form of ulnar wards rotation and hyperextension of the
metacarpophalangeal joint, together with a prominent palpabb head of the
litth metacarpal over the volar aspect of the joinl and a dosed complex
ineducible dorsal dislocation ol the metacarpophalangeal joint of the little
finger with Salter and Harris type ll epiphyseal fracture of the fifth rnetacar?al
epiphysis(Fig.4).
Figure ( 3 )
Figure ( 4 )
-202-
5. r
DORSAL IRREDUCIBLE DISLOCATION
JOINT OF INDEX IN LITTLE FINGER.
F.ABU HASSAN & S.EL.HADIDY
Open reduction was elected as the method of trqatment using the
volar Kaplan's approach
( to )
-d if needed to use the dorsal Farabeuf's
incision ( Fig. a, I ) ;the technique of tre operation irrclude the following :
- ldentllicatlon and rebaction of the Neurovascular bundle.
- The superlicial transverse metacarpal ligament had to be incised to
facilitate the exposwe & re<luction.
- Release ol A1 pulley showed enlrapment of the volar plate inside the ioint.
- Using a blunt hook and some dissection the volar plate was removed
from the inside of the ioint.
- Reduction of the dislocation was easy without lhe need of.the dorsal
incision.
- Repair of the volar plate to its insertion on lhe metacarpal nodc
- Kirscfiner wire was used to maintain the reduction in moderate flexion of
the metacarpophalangeal joint.
The Little finger of the left hand was managed by Volar approach and
without need for the dorsal approach Also, Kirschner wire was used to
maintain the reduction.
Patient was discharged home on the second post operative day. The
Kirschner wires were removed at four weeks but the Volar Slab was kept lor
another two weeks. After that an intensive exercise program was started.
Eight weeks post operatively the patient recovered with a good and full range
of motion. Six months post operatively, he had full range ol motion, !;ood
scare ( Fig 5 , 6, 7 ) and he is play{ulas ewr.
Figure ( 5 )
-203-
7. I
{
$
t
{
DORSAL IRREDUCI BLE DISLOCATION
JOINT OF INDEX IN LITTLE FINGER.
F.ABU HASSAN & S.EL.HADIDY
DrscussloN
Ineducible dislocation of the metacarpophalangeal ioints were first
described in 1855 by Malgaigne
( 17 ). The term coqp]?x dislocation was
coined by the French surgeon Farabeul in 1876
1e) an9 the dorsal
approach is stitt called the Farabeuf 's dorsal incision
( Q 9 ).. tt'" tsrm
T[|fi6;-, (-b;aG;l ir,ir'mi,lripre _anitomic
srrucrures whicfr block the
reOuctiin 1 wis introduced to the. English Literature in 1888 and 1910 by
Battle(
7 ) and Barnard
(5 )
,"rp*riwly.
Thepatho|ogicanatomywasnotwide|yappreciatedunti|
Kaplan
( la)in 1957 described the button holing of.the metacarpal.head
i#ffih the voiarplate,wnict
-Uieafs
away at its weakest attac{rment to the
neck of the votar aspect of the metacarpal bon€ , |.]t'.*9. into the palmar
ItiuituidJ *tricrr ne'catleo ttte cfrineso iinger traplike.
-lo9ki.ns
mechanism'
These complex structures were demonstrated properly
( 3' 20 )
'
Recent studies showed that it is most frequently affecting the
index
( 1' 3' 4' 8' 12' 13' 14'?f.'tt), fol6*"d bythethumb,
(1a'21)
tten by
the little finger
( 5
'7'13 ) '
23 ) the middle and dng finger are being the
. ( 1,3,4,7,12,13)
rare6t
lmbriglia and Sciuli concluded that the border-digits-were rnore otten
attected Ueci-use of inJpnysical vulnerability and lack ol stabilization of the
adjacent intermelacarpal ligamenF
( 13 ).
Asscociated volar wound with the irreducible dislOcation are
,"r"
(to' 1t ) . Th" oombination of a complex compound irreducible dorsal
dislocation together with a fracture was reported- byviegas 9'"l
( a )*he'e
;-t"-rfii iuiiiineO I iomptex compdund frahura dislocation of the
ri"""rpophalangealioint ot ine fttn finger with a cominuted fracture of the
proximal phalanx . In 1988 gglan.et 9l ' ls ).reportedloYlgTg oJ gqmplgl
illedutiUie
-Oislocaiion-
oiiil index metaiarpophalangeal ioint with
Osteoctrondral fractures which were treated by open surgery'
Late presentation of the irreducible dislocation of the
metacarpophalingeal ioints are rare reaching up to few months
( 4'5'6'8'20' 21'24'25 ).Th" l"t" presentation is attributed to delayed palient
advice
( s )
"nd
failure of proper reduction by using lateral
"ppro"rr,
( m ).
]t is thought that the prognosis was poor il the treatment
of the Oislocaiion started
'thiee weeks or more following
-?n
8. JORDAN MEDICAL JOURNAL voL. 26 NO. 2.NOV.1gg2
inlury
( 3'4'5'8'15'20'24'25)
, MC Lar4ghlin proposed a pdmary artrrodesis as
the best treatment
( 18 )
, while other advocated metacarpal head
,"u""tion
( 21 ).
' Delayed cases could be also treated suecess fully with open
reduc{ion using modilled Kaplan's volar approacfi with radial extension
( & )
or exlended midlaterally or medially
(24'25 ).
rn" Association with arm
bones fractures were previously reported
( 121
Ou cass presented the
oombination of ineducible dorsaldislocation with epiphyseal lractures type ll
together with green sick fracturos of both radius and ulna with a vdar healed
wound.
Although lhe surgical management of chronic dislocation in
associated with a limited movernent of the metacarpophalangeal ;oint
( m )
and ischaemic necrosis ol the metacarpal head
( 3' 15 ) . Our case
demonstrated that chronic dislocation can still be succeselully managed by
an open method wilhout the need to resort to arthrcdoels or resection.
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F.ABU HASSAN & S.EL-HADIDY
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