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      Necesitamos revisar las heridas en dorso de mano y antebrazo Translated title: Nécessité de la mise en charge des blessures du dos de la main et l'avant-bras Translated title: It is necessary to inspect the wounds in hand dorsum and forearm

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          Abstract

          INTRODUCCIÓN: Las lesiones en dorso de mano son urgencias frecuentes de un hospital. Estudiar la relación existente entre la clínica inicial y la afectación tendinosa subyacente en heridas localizadas en esta región. Así como valorar la localización exacta, tipo, y etiología de ellas, por medio de un estudio observacional. MÉTODOS: Se realizó un estudio transversal, en el que se valoran 51 pacientes con 55 heridas en dorso de mano y antebrazo, tratadas en urgencias de nuestro hospital durante el periodo de junio a diciembre de 2009. RESULTADOS: La exploración inicial nos ofrece una especificidad y un valor predictivo positivo del 100 %, pero una sensibilidad del 17,14 % y un valor predictivo negativo del 40,81 % con respecto a la presencia de lesión tendinosa. CONCLUSIÓN: Ante la falta de correlación entre la clínica inicial con una posible lesión tendinosa extensora recomendamos la exploración quirúrgica de las heridas en dorso de mano, por su sencillez y aprovechamiento del acto quirúrgico.

          Translated abstract

          INTRODUCTION: Les lésions du dos de la main sont des urgences fréquentes d'un hôpital. Le but de cette étude est d'étudier la relation existant entre la clinique initiale et l'affection tendineuse sous-jacente des blessures localisées à cette région, et d'évaluer la localisation exacte, le type et l'étiologie par une étude observationnelle. MÉTHODES: Une étude transversale, portant sur 51 patients atteints de blessures (55) au dos de la main et l'avant-bras, et traités au service des urgences de notre hôpital entre juin et décembre 2009, a été réalisée. RÉSULTATS: L'exploration initiale nous montre une spécificité et une valeur pronostique positive de 100%, mais une sensibilité de 17,14% et une valeur pronostique négative du 40,81% par rapport à la présence des lésions tendineuses. CONCLUSIONS: Devant l'absence de corrélation entre la clinique initiale et une possible lésion du tendon extenseur, il est conseillé de faire une exploration chirurgicale des blessures du dos de la main, car elle est simple et très utile.

          Translated abstract

          INTRODUCTION: Injuries in hand dorsum are frequent hospital emergences. It is necessary to study the relation between initial clinics and the tendinous injuries underlying in wounds present in this region, as well to assess its exact location, the type and etiology through observational study. METHODS: A cross-sectional study was conducted to assess 15 patients presenting with wounds in the hand dorsum and forearm, treated in emergency room of our hospital from June to December, 2009. RESULTS: The initial screening offer us a specificity and a positive predictive value of the 100%, but a sensitivity of 17,4% and a negative predictive value of 40,81% regarding the presence of the tendinous injury. CONCLUSION: Due to a lack of correlation between the initial clinics and a possible extensor tendinous injury, it is recommended the surgical exploration of hand dorsum injuries due to its simplicity and use of surgical act.

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          Most cited references12

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          Physical activity and hypophysectomy on the aerobic capacity of ligaments and tendons.

          Traditionally, ligaments and tendons (L and T) have been regarded as metabolically inert structures. However, sufficient biochemical evidence on the metabolism of collagen has indicated that such a concept is no longer tenable. To determine whether L and T respond to increased or decreased levels of chronic exercise, studies were undertaken to measure their aerobic capacities. For comparative purposes, similar measurements were obtained from liver and skeletal muscles secured from normal and hypophysectomized male rats. Oxygen consumption and cytochrome oxidase (CO) activity was recorded from cell suspensions that had been prepared with the inclusion of collagenase and with elastase added to the medium. The O2 results showed that L and T had values that were approximately 10 times lower than liver tissue and 7.5 times less than the means from skeletal muscles. Hypophysectomy caused marked reductions in O2 uptake of liver and muscle tissues; but had no impact on L and T. When CO activity of these connective tissues were evaluated, immobilization and hypophysectomy caused significant reductions that ranged from -36% to -59% respectively. Training, on the other hand, resulted in increases of less than 10% in the activity of this enzyme within L and T while being elevated in muscle tissue by 58%. It was concluded that the metabolic activity of L and T was lowered with decreased levels of physical activity but it was unclear why chronic exercise did not produce the opposite effect.
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            Extensor tendon: anatomy, injury, and reconstruction.

            Although seemingly simple in its anatomy and function, the extensor mechanism of the hand is actually a complex set of interlinked muscles, tendons, and ligaments. A thorough understanding of the extensor anatomy is required to understand the consequences of injury at various levels. Reconstructive options must restore normal function. Whereas primary repair of anatomic structures is frequently possible in acute injury, it is rarely possible in chronic situations. Technically exacting procedures may be necessary to restore function.
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              Immediate controlled active motion following zone 4-7 extensor tendon repair.

              This article describes a splint management program for zone 4-7 extensor tendon repairs that allows for immediate controlled active motion (ICAM) of the repair and greater arcs of motion for adjacent digits. The splint is designed to relieve tension on the tenorrhaphy by positioning the involved digit in slight metacarpophalangeal joint hyperextension relative to the uninvolved digits with a simple yoke splint designed to control the metacarpophalangeal joints and a second splint to control wrist position. Cadaver and intraoperative trials support this technique, and 140 patient cases managed over 20 years. The majority of patients achieved a rating of excellent for both digital extension and flexion as judged by Miller's criteria. There were very few extension lags and no tendon ruptures. Patients returned to work in the ICAM splint on average in 18 days. The average time to complete the program was seven weeks after repair, and required an average of eight therapy visits. The results of this study demonstrate that the ICAM splinting technique is safe, simple to manage, decreases the morbidity associated with immobilization, is cost effective, and has high patient compliance when compared to other early motion programs.
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                Author and article information

                Journal
                ort
                Revista Cubana de Ortopedia y Traumatología
                Rev Cubana Ortop Traumatol
                Editorial Ciencias Médicas (Ciudad de la Habana, , Cuba )
                0864-215X
                1561-3100
                June 2011
                : 25
                : 1
                : 80-89
                Affiliations
                [01] Valencia orgnameHospital Universitario Doctor Peset Valencia España javitanaco@ 123456gmail.com
                [02] orgnameUniversidad Valencia España
                Article
                S0864-215X2011000100007 S0864-215X(11)02500107
                9ea2fd1a-5631-421e-bc21-1f5f6c25f973

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 18 March 2011
                : 12 May 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 10
                Product

                SciELO Cuba

                Categories
                ARTÍCULOS ORIGINALES

                dorsum,Tendon,extenseur,lésion,dos,main,déficit de l'extension,Tendón,extensor,lesión,dorso,mano,impotencia extensora,injury,hand,extensor deficit

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