The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Jun 2011
What kinds of hand injuries are more likely to result in amputation? An analysis of 6549 hand injuries.
We analysed 6549 hand injuries treated between 1992 and 2005 at a specialist hospital in Turkey to identify risk factors for amputations. There were 2899 (44%) hand amputations. Left-side injuries were more prone to amputation. ⋯ Doors were the most frequent objects of amputation in children, followed by powered wood cutters. Education, enforcement, and improved engineering are the keys to prevent amputations. Precluding illegal child labour is essential.
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J Hand Surg Eur Vol · May 2011
Screw prominences related to palmar locking plating of distal radius.
Fixation of unstable distal radius fractures with palmar locking plates provides a stable reduction and early return of function, but complications arising from unrecognized dorsally prominent screws penetrating the extensor compartments are increasingly reported. Standard radiographs and fluoroscopy may not adequately visualize screw lengths, owing to the complex shape of the dorsum of the distal radius. We examined 46 distal radius fractures treated with palmar locking plates by ultrasound. ⋯ The first extensor compartment was violated by one screw, the second compartment by 22 screws, the third compartment by 15 screws, and the fourth compartment by 21 screws. Asymptomatic tenosynovitis was detected in four and symptomatic tenosynovitis in 14 of the 59 prominent screws. Ultrasound imaging may be useful in cases where intra-articular and/or comminuted fractures require distal plate placement and engagement of screws in the dorsal cortex.
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J Hand Surg Eur Vol · May 2011
Finger zone II flexor tendon repair in children (5-10 years of age) using three 'figure of eight' sutures followed by immediate active mobilization.
For children between 5-10 years of age with zone II flexor tendon lacerations, the literature recommends a modified early mobilization programme under the supervision of a hand therapist but the fingers are immobilized between physiotherapy sessions. We report on a series of children between 5-10 years of age with flexor tendon lacerations (n = 54 fingers) in zone II repaired with a six-strand core suture (three separate 'figure of eight' sutures) and actively mobilized immediately after surgery similar to adult rehabilitation programmes with no immobilization between the physiotherapy sessions. ⋯ There were no ruptures. The final outcome was excellent in 46 fingers (85%) and good in the remaining eight fingers (15%) using the Strickland-Glogovac criteria.
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J Hand Surg Eur Vol · Mar 2011
Randomized Controlled TrialPatient controlled regional analgesia after carpal tunnel release: a double-blind study using distal perineural catheters.
This study was done to assess the efficacy of a perineural catheter for pain relief following carpal tunnel release (CTR). Sixty-six patients undergoing open CTR under local anaesthesia (LA) were randomly divided into three groups: Groups A and B had a perineural catheter and Group C served as non-blinded control group. Postoperative pain relief was by self-administration of either ropivacaine (Group A) or saline (Group B) via an elastometric pump and by oral paracetamol in Group C. ⋯ Fewer patients in Group A requested supplementary analgesics than in Group C. Patient satisfaction was higher in Group A than in Group B on day 1. However better analgesia was not associated with better functional recovery.