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Tämän opinnäytetyön tarkoituksena oli selvittää akuuttien nilkkavammojen konservatiivisia kuntoutusmenetelmiä sekä niiden vaikuttavuutta kudostyypeittäin. Tutkimusmenetelmänä käytettiin systemaattista kirjallisuuskatsausta. Alkuperäistutkimukset etsittiin PubMed- ja ScienceDirecttietokannoista. Opinnäytetyöhön hyväksyttiin 13 tutkimusta. Akuutit nilkkavammat ovat erittäin yleisiä esiintyvyydeltään. Useimmiten ne ovat ns. nyrjähdyksiä eli vääntövammoja, lateraalisten ligamenttien ollessa tällöin yleisin vaurioituva kudostyyppi. Nilkan nyrjähdykseen liittyy toisinaan myös luuvamma, ja syndesmoosivammojen esiintyvyys on diagnostiikan kehittyessä noussut. Myös hermo- ja jännekudokset saattavat vaurioitua nilkan akuuttivammassa, varsinkin alentunut peroneus-hermon johtavuus tavataan usein nilkan nyrjähdyksen yhteydessä. Opinnäytetyöhön saatiin tuloksia akuutin nilkkavamman yhteydessä esiintyvistä luu-, syndesmoosi- ja ligamenttivammoista ja niiden konservatiivisten kuntoutusmenetelmien vaikuttavuudesta. Kudostyypistä riippumatta voidaan todeta, että konservatiivisessa kuntoutuksessa paras vaikuttavuus saadaan harkitulla mutta ajallisesti lyhyellä immobilisaatiolla ja aktiivisella harjoitus- ja manuaalisella terapialla.
We present a patient with compartment syndrome and entrapment of the superficial peroneal nerve due to a direct hit to the lateral part of the right lower extremity. The diagnosis of evolving compartment syndrome was made without delay and the patient was quickly taken to the operating theater. Intraoperatively, the entrapment of the superficial peroneal nerve caused by rupture and herniation of the peroneus tertius muscle was surprisingly observed at the site, where the nerve pierces the anterior compartment. The nerve was successfully released in conjunction with fasciotomies of the anterior and lateral compartments. Meticulous diagnosis of compartment syndrome is critical to prevent ischemic injury to muscles and nerves. Recognition of anatomy and anatomical variations is important to prevent iatrogenic injury in unusual circumstances.
Introduction Distal radius is the most common site of fracture in children, comprising 23%-31% of all paediatric fractures. Approximately one-fifth of these fractures are displaced. Completely displaced distal metaphyseal radius fractures in children have traditionally been treated with closed reduction. Recent evidence suggests that correcting the shortening in over-riding distal metaphyseal radius fractures is not necessary in prepubertal children. To date, no published randomised controlled trial (RCT) has compared treatment of these fractures in children by casting the fracture in bayonet position to reduction and pin fixation. Methods and analysis We will conduct an RCT to compare the outcomes of casting the fracture in bayonet position in children under 11 years of age to reduction and percutaneous pin fixation. 60 patients will be randomly assigned to casting or surgery groups. We have two primary outcomes. The first is ratio (injured side/non-injured side) in the total active forearm rotation and the second is ratio (injured side/non-injured side) in total active range of motion of the wrist in the flexion-extension plane at 6 months. The secondary outcomes will include axial radiographic alignment, passive extension of the wrists, grip strength and length of forearms and hands, patient-reported outcome QuickDASH and pain questionnaire PedsQL. Patients not willing to participate in the RCT will be asked to participate in a prospective cohort. Patients not eligible for randomisation will be asked to participate in a non-eligible cohort. These cohorts are included to enhance the external validity of the results of the RCT. Our null hypothesis is that the results of the primary outcome measures in the casting group are non-inferior to surgery group. Ethics and dissemination The institutional review board of the Helsinki and Uusimaa Hospital District has approved the protocol. We will disseminate the findings through peer-reviewed publications. Trial registration number NCT04323410. Protocol V.1.1, 29 September 2020.
OBJECTIVE: The arthroscopic and histological International Cartilage Repair Society (ICRS) scores are designed to evaluate cartilage repair quality. Arthroscopic ICRS score can give a maximum score of 12 and the histological score can give values between 0% and 100% for each of its 14 subscores. This study compares these methods in an animal cartilage repair model. This study hypothesizes that there is a significant correlation between these methods. DESIGN: A chondral defect was made in the medial femoral condyle of 18 pigs. Five weeks later, 9 pigs were treated with a novel recombinant human type III collagen/polylactide scaffold and 9 were left untreated to heal spontaneously. After 4 months, the medial condyles were evaluated with a simulated arthroscopy using the ICRS scoring system followed by a histological ICRS scoring. RESULTS: This porcine cartilage repair model produced repaired cartilage tissue ranging from good to poor repair tissue quality. The mean arthroscopic ICRS total score was 6.8 (SD = 2.2). Histological ICRS overall assessment subscore was 38.2 (SD = 31.1) and histological ICRS average points were 60.5 (SD = 19.5). Arthroscopic ICRS compared with histological ICRS average points or its overall assessment subscore showed moderate correlation (r = 0.49 and r = 0.50, respectively). The interrater reliability with the intraclass correlation coefficients for arthroscopic ICRS total scores, histological ICRS overall assessment subscore, and ICRS average points showed moderate to excellent reliability. CONCLUSIONS: Arthroscopic and histological ICRS scoring methods for repaired articular cartilage show a moderate correlation in the animal cartilage repair model.