The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Jul 2014
Morphology of the proximal and middle phalanx of fingers with regard to the Ascension PyroCarbon PIP total joint.
The Ascension PyroCarbon prosthesis has been used in proximal interphalangeal joint osteoarthritis. The dimensions of the intramedullary distal metadiaphyseal canal (isthmus) of the proximal phalanx and the base of the middle phalanx of cadaver fingers were investigated radiographically (n = 304) and macroscopically (n = 152). In up to 30% of the phalanges, the isthmus was smaller than the stem of the smallest proximal component size. ⋯ A critical examination of the isthmus in radiographs is recommended in planning. If the isthmus is clearly smaller than the smallest proximal component, insertion of the prosthesis could be inadvisable. A clear mismatch between the distal component and the middle phalanx base should be avoided due to the potential risk for late subsidence and failure of the prosthesis.
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J Hand Surg Eur Vol · Jul 2014
Comparative StudyIntercostal and pectoral nerve transfers to re-innervate the biceps muscle in obstetric brachial plexus lesions.
In obstetric brachial plexus lesions with avulsion injury, nerve grafting for biceps muscle re-innervation may not be possible owing to the unavailability of a proximal stump. In such cases, the intercostal nerves or medial pectoral nerve can serve as donor nerves in an end-to-end transfer to the musculocutaneous nerve. ⋯ Biceps muscle force ≥ Medical Research Council Grade 3 was achieved in 37 of 42 patients after a mean follow-up of 44 months. There was no statistical difference in the results in the medial pectoral nerve transfer group (n = 25) and the intercostal nerve transfer group (n = 17).
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J Hand Surg Eur Vol · Jun 2014
Angular correction related to excision of specific cords in fasciectomy for Dupuytren's disease.
Named cords were excised sequentially at fasciectomy for Dupuytren's disease and the resultant correction in the joint angle was measured intra-operatively in 99 fingers. Eighty-two metacarpophalangeal and 59 proximal interphalangeal joints were affected. At the metacarpophalangeal joint, excision of the central cord resulted in 82% correction in 69 joints, and spiral/lateral cord excision resulted in an additional 12% correction in 10 joints. ⋯ Subsequent division of the accessory collateral ligament resulted in a further 14% correction in 14 joints. Larger pre-operative angles of the proximal interphalangeal joint were associated with a retrovascular cord, and larger combined angles were associated with an increasing number of pathological structures involved. The data explain the complexity of surgery at the proximal interphalangeal joint, where four structures are implicated in causing flexion deformity.
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J Hand Surg Eur Vol · Mar 2014
Comparative StudyThe wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff's Test.
De Quervain's disease has different clinical features. Different tests have been described in the past, the most popular test being the Eichhoff's test, often wrongly named as the Finkelstein's test. Over the years, a misinterpretation has occurred between these two tests, the latter being confused with the first. ⋯ The wrist hyperflexion and abduction of the thumb test revealed greater sensitivity (0.99) and an improved specificity (0.29) together with a slightly better positive predictive value (0.95) and an improved negative predictive value (0.67). Moreover, the study showed us that the wrist hyperflexion and abduction of the thumb test is very valuable in diagnosing dynamic instability after successful decompression of the first extensor compartment. Our results support that the wrist hyperflexion and abduction of the thumb test is a more precise tool for the diagnosis of de Quervain's disease than the Eichhoff's test and thus could be adopted to guide clinical diagnosis in the early stages of de Quervain's tendinopathy.