The Journal of hand surgery
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Comparative Study
Comparison between partial and minimal medial epicondylectomy combined with decompression for the treatment of cubital tunnel syndrome.
We have performed minimal medial epicondylectomy for cubital tunnel syndrome since 1990 to preserve the anterior medial collateral ligament. In this study we compared surgical outcomes between partial medial epicondylectomy (14 patients) and minimal medial epicondylectomy (18 patients) combined with ulnar nerve decompression for the treatment of cubital tunnel syndrome. Mean preoperative Yasutake scores were 57 +/- 17 points (+/-SD) in the partial epicondylectomy group and 60 +/- 15 points in the minimal medial epicondylectomy group. ⋯ There was no significant difference in improvement of either the Yasutake scores or the motor conduction velocity between the 2 groups. Valgus instability of the elbow was significantly greater in the partial epicondylectomy group. We therefore conclude that minimal medial epicondylectomy combined with ulnar nerve decompression is an effective treatment for cubital tunnel syndrome and that a larger excision of the medial epicondyle should be avoided.
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Randomized Controlled Trial Comparative Study Clinical Trial
External fixation of the distal radius: to predrill or not to predrill.
Using both clinical and laboratory studies we investigated whether predrilling before insertion of external fixation pins is necessary for use in treating distal radius fractures. Our clinical study included 50 consecutive external fixators (4.0- and 2.5-mm pins) using 100 predrilled and 100 direct-drilled pins placed in a randomized manner. ⋯ There were, however, significantly elevated temperatures with the direct-drilled technique. We therefore recommend predrilling even though the temperature differences in this bone with this fixator were not clinically evident.
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Surgery on the extremity affected with complex regional pain syndrome (CRPS) is generally avoided because of the risk that the symptoms will recur or worsen. Perioperative sympathectomy or stellate ganglion block has previously been recommended for CRPS patients requiring surgery of the affected upper extremity. We evaluated 100 patients with a history of upper extremity CRPS undergoing surgery on the affected extremity. ⋯ After completion of the surgical procedure half of the patients (n = 50) underwent a stellate ganglion block; the other half received no intervention. The recurrence rate of CRPS was significantly lower in those patients receiving a postoperative stellate ganglion block (n = 5; 10%) compared with those receiving no intervention (n = 36; 72%). We conclude that performing a perioperative stellate ganglion block in patients with a history of CRPS can significantly reduce the recurrence rate of this disease process.