The Journal of hand surgery
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Perioperative management of systemic oral anticoagulants in patients having outpatient hand surgery.
Long-term oral anticoagulant therapy is frequently initiated in patients with elevated risk of venous or arterial thromboembolism. The most common indications for anticoagulation are chronic atrial fibrillation, mechanical heart valves, a history of venous thromboembolism, and hypercoagulable states. In the perioperative setting, these patients pose considerable challenges to physicians, who must weigh the thrombotic risks of therapy interruption against the bleeding risks of continuation. ⋯ Difficulties intrinsic to study design include a short duration of risk exposure, lack of patient uniformity, and rarity of baseline adverse events. Given the paucity of substantive evidence on which to base management decisions, physicians have long relied on clinical judgment to guide their choices. This review summarizes the available data specific to elective hand surgery and provide a general context in which evidence-based treatment decisions can be made.
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Comparative Study
Precontoured fixed-angle volar distal radius plates: a comparison of anatomic fit.
To compare distal radius volar fixed-angle plates for anatomic fit. ⋯ There was considerable variation in ideal plate location among the 7 plates tested. Total contact was minimal for all plates tested. The Synthes EA pin-subchondral bone distance was significantly greater than those of other plates tested. Joint penetration was relatively common, necessitating use of fluoroscopy and proper plate width.
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Scaphoid nonunions are a common complication of scaphoid fractures and frequently progress to degenerative arthritis. This study evaluated the effect of scaphoid nonunion on the in vivo kinematics of the radioscaphocapitate articulation. ⋯ Scaphoid nonunions have a dramatic impact on carpal kinematics, partially uncoupling the proximal and distal carpal rows. Although the results of this in vivo study differ from past in vitro studies, the increase in lunocapitate motion we identified is consistent with the current theory that the scaphoid acts as a fundamental link between the proximal and distal carpal rows.
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Comparative Study
Diagnostic comparison of 1.5 Tesla and 3.0 Tesla preoperative MRI of the wrist in patients with ulnar-sided wrist pain.
The diagnostic sensitivity, specificity, and accuracy of 1.5 Tesla (T) and of 3.0T magnetic resonance imaging (MRI) are correlated with wrist arthroscopy findings in patients presenting with ulnar-sided wrist pain. ⋯ The sensitivity, specificity, and accuracy of 3.0T wrist MRI for the TFCC is consistently higher compared with those of 1.5T wrist MRI. The trend suggests that 3.0T wrist MRI provides improved capability for detection of TFCC injuries. Given the available sample size, however, the confidence intervals around the point estimates are wide and overlapping. Further studies are needed to confirm or refute our results of the estimated sensitivity, specificity, and accuracy parameters.
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Comparative Study
Comparison of 2 surgical approaches for volar locking plate osteosynthesis of the distal radius.
To determine whether a volar radial (Henry) exposure to the distal radius is associated with less median nerve dysfunction than a direct volar exposure of the distal radius through the carpal tunnel that has been abandoned due to median nerve problems. ⋯ Therapeutic III.