chirurgia della mano
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Le Patologie della mano

Tantissime sono le patologie che interessano la mano in senso lato. Negli anni il cosiddetto Chirurgo della Mano ha esteso il suo campo diventando l' "esperto" di mano polso gomito a volte della spalla sempre dei nervi periferici anche negli arti inferiori sempre della chirurgia ricostruttiva con lembi microvascolari.
Qui presentiamo alcune delle patologie pi comuni che riguardano le anomalie congenite, i traumi e gli esiti dei traumi con ricostruzioni tradizionali e microchirurgiche, le patologie artrosiche e reumatiche e le patologie nervose.

 
   
 
Distal radius osteotomy and Sauvè-Kapandji procedure  in    young adults Madelung’s deformity  management.


Madelung deformity has pattern of excessive anterior and ulnar bowing  of distal radius with dorsally prominent ulnar head.

The etiology is unknown:deficient growth in the volar ulnar portion of distal radius growth plate seems to cause deformity in association with abnormal palmar ligament from lunate to radius proximal to the physis(Vickers ligament)




Often as isolated deformity,sometimes in conjuction with other dysplasias (Leri-Weill dyschondrosteosis-LWD, most common association; SHOX short stature homeobox-containing gene associated with LWD; microanatomy of phises and palmar ligament of patients with Madelung deformity and SHOX showed abnormal physeal architecture. 0Nail Patella Syndrome-onycho-osteodysplasia is associated with Madelung.
Repetitive trauma or loading on the growing wrist may cause a pseudoMadelung.)

Madelung is commonly observed bilateral with female prevalence and usually presenting  between the ages of 6 and 13.

No classification; rarely reverse Madelung




Despite clinical patterns patients have often minimal functional impairment;surgical options are necessary for painful or cosmetically unacceptable deformity.

In skeletally immature asymptomatic patients we can think to physiolisys with abnormal ligament release

In young adults(skeletally mature)with wrist pain several techniques are proposed as radial osteotomy and ulna shortening  distal ulna resection or Sauvè Kapandij








22 young adults in ten years

5 with painful wrist non responding to non surgical treatment and/or with significant cosmetic deformity required surgical reconstruction

Four female one male; three on dominant wrist and two bilateral
We perform osteotomy of radius (1closing-6 opening wedge) with K.wires(3), staples (2),plates and screws(2); five osteotomies of radius by dorsal approach and two by volar

Sauvè Kapandij with screws(3) Herbert(2)Acutrak(2)


Results:

Cosmetic improvement with god functional results and pain resolution

In osteotomy of radius stabilized with K.Wires we had pin site irritation and in one case a delaied consolidation



Despite Madelung is often without symptoms sometimes in adolescents and young adults pain  functional limitations and deformity became unacceptable.So patients require treatment

With skeletally mature patients osteotomy of radius with Sauvè Kapandij remove cosmetic deformity functional deficit and pain.

For stabilitation of Sauvè Kapandij Acutrak screw is helpful;for the osteotomy of radius volar approach seems to be useful




 

 

 
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