The Journal of hand surgery
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Comparative Study
Treatment of trigger finger in patients with diabetes mellitus.
We present a retrospective study of 54 diabetic patients with 121 trigger digits treated over a 3-year period by one to three injections of corticosteroid mixed with local anesthetic. As a group, diabetic patients responded less favorably to treatment by steroid injection (50% symptom resolution) when compared to reported outcomes of steroid injection treatment for stenosing tenosynovitis in the general population. Insulin-dependent diabetic patients have a higher incidence of multiple digit involvement (59% of patients) and of requiring surgical release for relief of symptoms (56% of digits) when compared to non-insulin-dependent diabetic patients (28% of patients with multiple digit involvement; 28% of digits requiring surgery).
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A retrospective review of 25 consecutive patients with 28 proximal phalangeal fractures was performed. Fractures of the thumb were excluded. Twenty-five fractures were closed and three were open. ⋯ One fracture showed appreciable malrotation of 10 degrees. Flexible intramedullary rodding of specific proximal phalangeal fractures provides excellent results with a low complication rate. Proper selection of fractures and good surgical technique are necessary to avoid complications.
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Between 1989 and 1991, 137 nonunions of the scaphoid were treated by the senior author, who noted that 26 of these nonunions had an avascular proximal pole (no punctate bleeding from the bone at the time of surgery). All 26 nonunions were treated with iliac crest bone grafting and Herbert screw fixation. Of these 26 patients, 17 were followed for more than 1 year after their surgery (average follow-up period, 31 months). ⋯ No patient has required either a proximal row carpectomy or wrist arthrodesis. Previously published results of avascular proximal pole scaphoid nonunions suggest that union cannot be obtained and functional results are uniformly poor. In contrast, the functional and x-ray results of our patients are markedly improved over these previous studies--emphasizing the importance of iliac crest bone grafting, rigid internal fixation, and appropriate postoperative immobilization.