The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Oct 2002
Scaphoid nonunion: treatment with a pedicled vascularized bone graft based on the 1,2 intercompartmental supraretinacular branch of the radial artery.
Pedicled vascularized bone grafts (Zaidemberg's technique) were used to treat 22 established scaphoid fracture nonunions, 16 of which were found to have avascular proximal poles at surgery. After a follow-up of 1-3 years, only six (27%) of the 22 fracture nonunions had united. Only two of the 16 nonunions with avascular proximal poles united, compared with four of the six nonunions with vascular proximal poles. We conclude that this technique of pedicled vascularized bone grafting may not improve the union rate for scaphoid fracture nonunions with avascular proximal pole fragments.
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J Hand Surg Eur Vol · Oct 2002
The role of the extensor digitorum communis muscle in lateral epicondylitis.
A common finding in tennis elbow is pain in the region of the lateral epicondyle during resisted extension of the middle finger (Maudsley's test). We hypothesized that the pain is due to disease in the extensor digitorum communis muscle, rather than to compression of the radial nerve or disease within extensor carpi radialis brevis. Thirteen human forearm specimens were examined. ⋯ The results confirmed the high prevalence of a positive Maudsley's test in lateral epicondylitis, and also that the patients with tenderness at the site of origin of the extensor digitorum communis slip to the middle finger had the greatest pain during middle finger extension. These anatomical and clinical findings clarify the anatomy of extensor digitorum communis, and suggest that this muscle forms the basis for the Maudsley's test. The muscle may play a greater role in tennis elbow than previously appreciated.
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J Hand Surg Eur Vol · Oct 2002
Randomized Controlled Trial Clinical TrialTopical anaesthesia to reduce pain associated with carpal tunnel surgery.
This randomized, double-blinded study assessed the effectiveness of a topical anaesthetic, eutectic mixture of local anaesthetics (EMLA), in reducing pain associated with carpal tunnel release performed under local anaesthetic. Fifty-six patients undergoing carpal tunnel release under local anaesthetic were randomized into either EMLA (n = 29) or placebo (n = 27) groups. ⋯ Pain scores were significantly less for needle insertion (P = 0.001) and injection of anaesthetic (P = 0.0005). Scores related to surgery were also lower in the EMLA group, but this did not reach statistical significance.