The Journal of hand surgery, European volume
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In a prospective study we performed bone scans on 84 patients who had sustained a wrist injury and in whom a scaphoid fracture was clinically suspected but could not be confirmed on the original set of five routine "scaphoid view" radiographs. In 40 patients the bone scan was normal and in 25 there was increased uptake in areas other than the scaphoid. ⋯ In seven of these a scaphoid fracture was subsequently demonstrated on repeat radiographs (five cases) or a CT scan (two cases). In the remaining 12 no fracture could be demonstrated.
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It has been suggested that a positive scaphoid compression test will reliably confirm the presence of a fractured scaphoid in those patients presenting with an injury clinically suggestive of this, but without a fracture visible on initial X-rays. A prospective study was carried out in 99 patients presenting with an injury clinically suggestive of a scaphoid fracture. 74 patients had positive scaphoid compression tests with 24 of these patients having a scaphoid fracture visible on initial X-ray and seven having a fracture diagnosed either by repeat X-ray or bone scan 2 weeks after injury. 25 patients had a negative test, with ten having a scaphoid fracture visible on initial X-ray and three on repeat X-ray at 2 weeks. These results show that this test had a sensitivity of 70.5%, a specificity of 21.8% and predictive value of 41.9%. A positive scaphoid compression test is an unreliable diagnostic aid for a scaphoid fracture.
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J Hand Surg Eur Vol · Oct 1994
Case Reports Comparative StudySellotape ischaemic injury to the fingertip.
A case is reported of significant ischaemic damage to a fingertip from the use of Sellotape. The elasticity of Sellotape has been tested and compared with that of Elastoplast, illustrating the stiffness of Sellotape and thus emphasizing its unsuitability. The general public needs to be aware of the dangers of using non-proprietary dressings and the medical profession must remain vigilant about the elasticity of dressings.
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Phalangeal neck fractures are uncommon in children. When these injuries to the proximal and middle phalanges are displaced and not treated operatively the fracture may heal in a malunited position with loss of motion at the IP joint. ⋯ In cases of malunion osteotomy of the phalangeal neck may be required to restore anatomy and motion. A case is described which demonstrates complete remodelling of a displaced middle phalangeal neck fracture in a child and recovery of a normal range of motion without operative intervention.
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J Hand Surg Eur Vol · Oct 1994
Clinical TrialDistal radial osteotomy for malunion of wrist fractures in young patients.
Malunion after a fracture of the distal radius in a young patient causes a significant disturbance of wrist function. We have performed distal radial osteotomies in 11 patients to correct radial malunion. Surgery was indicated in young patients with functional disability in the wrist due to limited wrist motion and pain. ⋯ Post-operatively combined dorsal and volar flexion improved from a mean of 34 degrees to 72 degrees. Combined pronation and supination improved from a mean of 68 degrees to 106 degrees. Pain assessed on a simple four-point functional score was decreased from a mean of 3.3 to 1.3.