The Journal of hand surgery, European volume
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J Hand Surg Eur Vol · Jun 1992
Perineural pressures under the pneumatic tourniquet in the upper extremity.
The literature indicates that tourniquet-induced neurological injuries are relatively common and frequently occur at a subclinical level. In order to evaluate the pressure transmitted to the major peripheral nerves of the arm by an externally applied pneumatic tourniquet, a fully implantable biomedical pressure transducer was placed adjacent the radial, median and ulnar nerves in six cadaver upper extremities of average dimensions. This sensor allowed accurate, reproducible measurements of perineural pressures without requiring significant disruption of the normal anatomical structures of the test limb for its installation. ⋯ This was most marked at the highest levels of tourniquet inflation. At presently accepted levels of inflation, pneumatic tourniquet cuffs transmit high pressures to the peripheral nerves without any significant attenuation by the intervening soft tissues. The distribution of these forces is one which may subject the underlying nerves to deleterious shear forces, especially at higher levels of inflation.
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A prospective study of the management of 30 patients with 37 unstable or complex metacarpal or phalangeal fractures treated with the "Shearer" micro-external fixator was carried out over an 18-month period. The stability achieved, with minimal soft-tissue tethering, allowed early joint mobilisation with good or excellent function in 94% of metacarpal and 85% of phalangeal fractures by nine weeks. There were no cases of non-union and few complications.
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J Hand Surg Eur Vol · Dec 1991
The superficial anastomosis on the palm of the hand between the ulnar and median nerves.
The communications between the median and ulnar innervated territories on the palm of the hand have been studied anatomically and microscopically. A communicating branch is well appreciated but its description has had little emphasis in anatomical or surgical literature. 50 cadaveric palms were dissected in both sexes and an anastomotic branch was found in 45 hands. ⋯ By microscopic dissection we have seen that the ulnar fibres of the anastomotic branch which join the median nerve may contribute to the sensory innervation of the radial half of the ring finger and ulnar side of the middle finger on its palmar surface. We have therefore described a cutaneous area on the palm where care must be taken to avoid surgical damage to this branch.
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J Hand Surg Eur Vol · Nov 1991
Comparative StudyHuman fight-bite injuries of the hand. A study of 100 cases within 18 months.
100 consecutive patients whose finger had been bitten by another person, or who had cut it on a tooth in a fight, have been studied. 82 healed completely but 18 eventually needed amputation. Early and thorough debridement is required, plus a suitable mixture of antibiotics. Once infection is established in bone or tendon sheath, amputation is often needed, but most infected joints can be saved.