The Journal of hand surgery
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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.
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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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Closed reduction and percutaneous pinning is a reliable technique for treating 2- and 3-part distal radius fractures. There are currently no data that demonstrate the proximity of at-risk nerves and tendons during percutaneous placement of 5 commonly used K-wires. Whereas the previous literature notes the risk of superficial radial nerve injury with K-wire insertion into the radial styloid, the current study provides specific distances, not only to the superficial radial nerve (SRN) but also to the tendons of the first through fifth extensor compartments during K-wire insertion. ⋯ The volar radial styloid, transverse radial, and dorsoulnar K-wires all penetrated either tendons or nerves. It is therefore prudent to make a small incision to identify and protect the underlying structures prior to placement of K-wires used for the fixation of distal radius fractures. Also, care must be taken not to place the dorsal K-wires more than 5 mm ulnar to Lister's tubercle to avoid extensor digitorum communis injury.