The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Feb 2006
External fixation of closed metacarpal and phalangeal fractures of digits. A prospective study of one hundred consecutive patients.
Stable and undisplaced phalangeal and metacarpal fractures treated with strapping or functional splinting and controlled active exercises offer from about 70 to 80% of good results. The goal of treatment of closed unstable and displaced fractures should be to achieve similar or better outcome. ⋯ This combination was used in a prospective study of 100 consecutive patients with closed fractures of the proximal and middle phalanges and the distal three-quarters of the metacarpal bones. Good clinical results (TAM > or = 230 degrees) were obtained in 76% of isolated phalangeal fractures, in all metacarpal fractures and in 89% of multiple fractures.
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J Hand Surg Eur Vol · Dec 2005
Randomized Controlled TrialThe use of a fine-gauge needle to reduce pain in open carpal tunnel decompression: a randomized controlled trial.
This randomized controlled study on 86 patients compared the level of pain experienced by patients on instillation of local anaesthetic into the palm with a 23-gauge and a 27-gauge (dental) needle in open carpal tunnel decompression. Patients were asked to score the amount of pain they experienced during the injection of the local anaesthetic and their level of anxiety about future injections using a visual analogue scale (VAS) and a four-point verbal response scale (VRS). ⋯ There was significant correlation between the pain and anxiety VAS scores. When infiltrating local anaesthetic into the palm for open carpal tunnel decompression, the use of a fine (dental) needle can reduce the pain on that occasion and the anxiety concerning future injections likely to be experienced by the patient.
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J Hand Surg Eur Vol · Dec 2005
Complex regional pain syndrome type 1 after fractures of the distal radius: a prospective study of the role of psychological factors.
A prospective study was designed to investigate the question "Do patients who develop Complex Regional Pain Syndrome Type 1 (CRPS Type 1) after fracture of the distal radius display different psychological behaviour patterns and/or are more depressive than those who recover uneventfully after this fracture?" Sixty-two patients of mean age 56 years with displaced distal radius fractures were operated on by closed reduction and percutaneous fixation with K-wires. All these patients were examined psychologically on the day after the operation. A series of standardized, self-administered questionnaires was used to assess personality and depression. ⋯ Nine patients (18%) were diagnosed as having CRPS Type 1. There were no significant differences in scores on any of the personality and depression scales between CRPS Type 1 and non-CRPS Type 1 patients. Therefore, patients who eventually developed CRPS Type 1 after radial forearm fracture had neither a unique psychological pattern nor displayed more symptoms of depression than those who recovered uneventfully.
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The typical Dupuytren's disease patient is of Northern European descent with bilateral progressive multiple digital contractures and is genetically predisposed, with a family history. Palmar fascial proliferations sometimes present as a different entity without the typical Dupuytren's disease characteristics. We identified 39 patients (20 women and 19 men) over a 4-year period with "Non-Dupuytren's palmar fascial disease", with unilateral involvement, without family history or ectopic manifestations. ⋯ Environmental factors, especially trauma, surgery and diabetes, are important in the pathogenesis of Non-Dupuytren's palmar fascial disease, but these patients do not appear to be genetically predisposed for Dupuytren's disease. Typical Dupuytren's disease and Non-Dupuytren's palmar fascial disease are two clinical entities that run different courses and do not share a similar prognosis. This should be taken into account in future epidemiological and outcome studies.