The Journal of hand surgery
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Decision analysis is a method of probabilistic reasoning and decision-making under conditions of uncertainty. These methods are being used increasingly in hand surgery and medicine in general. ⋯ Performing a decision analysis involves (1) defining a specific question, (2) creating a model to frame the question, (3) assigning value to outcomes in the model, (4) assigning probabilities to chance events in the model, (5) identifying the best strategy within the model, (6) sensitivity analysis, and (7) model refinement. It is important to recognize the limitations inherent in decision analysis but also to understand its value in overcoming clinical uncertainty by employing a practical technique of modeling choices and outcomes.
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Fracture-dislocations in the small joints of the fingers are challenging injuries. The surgeon must choose an appropriate treatment based on fracture pattern, joint stability, and injury chronicity. ⋯ Similar injuries in the distal interphalangeal joint are more tolerant of fracture displacement and even joint subluxation. Dorsal dislocations of the metacarpophalangeal joint may be associated with shearing fractures of the metacarpal head but are most notable for the volar plate interposition that may block closed reduction.
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The primary aim of our study was to investigate use of long axis computed tomography (CT) in predicting avascular necrosis of the proximal pole of the scaphoid and subsequent fracture nonunion after internal fixation. In addition, we describe a new technique of measuring the position of a scaphoid fracture and provide data on its reproducibility. ⋯ Diagnostic II.