Injury
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Poor awareness among the patients and lack of resources for proper management of nerve injuries leads to delayed presentation of most traumatic ulnar nerve injuries. When this injury is present in the proximal forearm it leads to poor outcomes as Ulnar nerve repair with grafts takes a prolonged time to restore function. Addition of a tendon transfer to this procedure can allow patients to return to work earlier. The purpose of this study is to examine whether the addition of a tendon transfer to nerve repair surgery will lead to improved hand function and rehabilitation earlier than nerve grafting alone in cases of delayed presentation of Ulnar nerve injuries. ⋯ On comparison of employment status at 6 months we found that among the tendon transfer group 15/20 (75%) were employed while only 4/16 (20%) in the control group were able to return to work. Chi square test shows a p value of 0.002 (significant at p < 0.05). On evaluation at end of 1 year after surgery we found 18/20 (90%) had returned to work in the tendon transfer group while 8/16 (50%) had found employment again in the control group. Chi square test shows a p value 0.007 (significant at p < 0.05) CONCLUSION: These outcomes suggest that addition of a tendon transfer with nerve grafting promotes early rehabilitation, especially in patients employed in manual labor.
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Review
Gunshot injuries to the lower extremities: Issues, controversies and algorithm of management.
Civilian gunshot violence is common and concentrated in specific geographic regions of the world, consuming a significant proportion of trauma practice in those particular regions. Unfortunately, the state of clinical evidence is scarce, and it is fair to emphasize that the field is scientifically under-represented. ⋯ The proposed concepts are based on available evidence from the literature and expert opinion. The authors also highlight challenges with conducting clinical studies in the field, given the high rate of 'loss to follow-up' and compliance issues in this particular group of patients.