The Journal of hand surgery
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Upper-extremity impairment evaluation is performed mostly by using guidelines provided by the American Medical Association (AMA). Recently, subjective disability tests, such as the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, have been developed that appreciate the limitations patients experience in everyday life. In this study, the correlation between impairment and disability was assessed after treatment for severe hand injuries with multiple phalangeal fractures, with adjustment for comorbidity and follow-up duration. ⋯ The lack of a strong correlation emphasizes the clear distinction between impairment and disability. The inclusion of disability outcome measures in the evaluation of hand trauma regimens might help to expand the clinician's view to more individualized, activity-of-daily-living-oriented, treatment regimens.
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Proximal row carpectomy (PRC) is a clinically useful motion-sparing procedure for the treatment of certain degenerative conditions of the wrist. Clinical outcome studies after PRC have shown that wrist flexion-extension averages approximately 60% of that of the contralateral wrist. The purpose of this study was to determine how the kinematics of the wrist are altered after PRC. ⋯ Removal of the proximal carpal row decreased normal wrist flexion and extension. Although ulnar deviation was preserved, radial deviation was limited by impingement of the trapezoid on the radial styloid. Radiocapitate range of motion after PRC was greater than capitolunate range of motion in the intact wrists. Compared with previously published requirements, wrist range of motion observed after PRC was sufficient for activities of daily living.
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To retrospectively review the surgical technique, postoperative therapy/splinting protocols, and clinical and radiographic outcomes of patients who had pyrolytic carbon proximal interphalangeal (PIP) joint arthroplasty. ⋯ Therapeutic, Level IV.
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Computed tomography (CT) can be used to triage suspected scaphoid fractures. This study assessed intraobserver and interobserver reliability and positive and negative predictive values of CT for the diagnosis of a nondisplaced scaphoid fracture. ⋯ Computed tomography should be used with caution for triage of nondisplaced scaphoid fractures because false-positive results occur, perhaps from misinterpretation of vascular foraminae or other normal lines in the scaphoid. Given the relative infrequency of true fractures among patients with suspected scaphoid fractures, CT is better for ruling out a fracture than for ruling one in.
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Outcomes study of distal radius fracture (DRF) treatment has been hampered by an uncertainty regarding the most appropriate outcomes assessment tool to evaluate the effectiveness of treatment. This study aimed to measure the responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) and physical measurements to assess the value of these outcomes tools for DRF studies. ⋯ Unlike other conditions such as carpal tunnel syndrome, for which the outcomes questionnaire is the most responsive measure, in DRF treatment both the MHQ and physical tests are responsive in measuring outcomes and should be reported for outcomes studies of DRFs. The MHQ and physical tests can be used for outcomes research related to DRF with the advantage of also being useful for assessing and comparing outcomes for other hand disorders.