The Journal of hand surgery
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The pi plate (Synthes Ltd, Paoli, PA) was designed to fit the unique contour of the dorsal aspect of the distal radius. Complications of pi plate fixation of the dorsal distal radius have been previously reported to include both extensor tenosynovitis and delayed extensor tendon rupture. We report a case of rupture of the flexor pollicis longus tendon associated with inappropriate placement of the pi plate on the volar surface of the distal radius.
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Extensor triggering is an uncommon but recognized component of de Quervain's stenosing tenosynovitis. In a retrospective review of 827 patients with the diagnosis of de Quervain's disease over a 5-year period, 11 patients with 13 affected wrists were identified who had demonstrable triggering by both history and physical examination (prevalence of 1.3%). One wrist underwent surgical release without conservative treatment. ⋯ After an average follow-up period of 42 months (range, 5.7-94.5 months) there were no recurrences of triggering after surgical treatment. Seven of 12 wrists with triggering de Quervain's stenosing tenosynovitis failed nonoperative treatment. Triggering or locking in extension is an uncommon symptom in de Quervain's stenosing tenosynovitis and demonstrates a more recalcitrant course when treated nonoperatively.
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Comparative Study
Comparison of nail bed repair versus nail trephination for subungual hematomas in children.
Fifty-three fingers in 52 children were divided into 2 groups, operative and nonoperative, after fingernail crush injury. Criteria for inclusion into the study were an intact nail and nail margin with subungual hematoma and no previous nail abnormality. The length of the follow-up period averaged longer than 2 years for each group. ⋯ Although formal nail bed reconstruction has been advocated for hematomas larger than 25%, we found no notable difference in outcome between the 2 groups regardless of hematoma size, presence of fracture, injury mechanism, or age. Charges, however, were 4 times greater for the operative group. Based on the results of this study, we do not feel that nail removal and nail bed exploration is indicated or justified for children with subungual hematoma and an intact nail and nail margin.
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Pressure reduction for standard open fasciotomy and a novel endoscopic fascial release were compared in experimental conditions of elevated forearm compartment pressures by continuously monitoring intracompartmental pressures in 22 cadaver forearms. Both methods were effective in diminishing tissue pressures. Intracompartmental pressures were reduced to significantly lower levels following open versus endoscopic assisted fasciotomy (2.9 mm Hg vs. 13.2 mm Hg). ⋯ The results of this study suggest that endoscopic assisted fasciotomy can reduce elevated tissue pressures, confirming previous findings that fascial release is of primary importance in decreasing intracompartmental tissue pressures. Open fasciotomy, however, gave significantly greater decompression than the endoscopic technique, a difference that may be even more substantial in the clinical setting due to several limiting factors of this in vitro model. Our results also suggest that immediate skin closure following fasciotomy increased tissue pressure and therefore should be avoided.
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Anatomic dissections under microscopic magnification were performed on 30 fresh cadaveric hands to depict the course and interconnections of the sensory nerves to the digits. The dissections included the median nerve, the ulnar nerve, the superficial branch of the radial nerve, the dorsal branch of the ulnar nerve, and the dorsal branch of the proper digital nerve. The communicating branches between the median and ulnar nerves in the palm were found in 20 of the 30 (67%) specimens. ⋯ Four types of palmar-dorsal interconnections, located in the middle of the proximal phalanx, were found in the digits but not in the thumb. The presence of these branches indicates dual innervation of the dorsal and palmar side of the distal areas of the digits. These anatomic findings may help hand surgeons interpret discrepancies in sensory loss after either dorsal or palmar injuries.