The Journal of hand surgery
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Randomized Controlled Trial Comparative Study
Blinded, prospective, randomized clinical trial comparing volar, dorsal, and custom thermoplastic splinting in treatment of acute mallet finger.
To compare volar, dorsal, and custom splinting techniques in acute Doyle I mallet finger injuries. ⋯ No lag difference was demonstrated between custom thermoplastic, dorsal padded aluminum splint, and volar padded aluminum splinting for Doyle I acute mallet fingers. Clinical measurement overestimates true lag in mallet injuries. Increased lag occurs after discontinuation of splinting. Increased age and complications correlate with worse radiographic lag.
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As the number of survivors of motor vehicle accidents and extreme sporting accidents increases, the number of people having to live with brachial plexus injuries increases. Although the injured limb will never return to normal, an improved understanding of the pathophysiology of nerve injury and repair, as well as advances in microsurgical techniques, have enabled the upper extremity reconstructive surgeon an opportunity to improve function in these life-altering injuries. The purpose of this review is to detail some of the current concepts of the treatment of adult brachial plexus injuries and give the reader an understanding of the nuances of the timing, available treatment options, and outcomes of treatment.
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Review
Reverse homodigital dorsoradial flap for thumb soft tissue reconstruction: surgical technique.
A variety of local flaps are described for reconstruction of soft tissue defects of the thumb. Restored sensibility, low donor-site morbidity, full restoration of function and range of motion, and an acceptable aesthetic outcome are requirements in thumb reconstruction. Reverse homodigital dorsal radial flap of the thumb provides most of these requirements and allows for dependable coverage of radiopalmar or dorsal thumb defects without affecting other digits.
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Intra-articular screw penetration is one complication of volar plate fixation of distal radius fractures. This study was designed to determine the most commonly used imaging techniques and views during volar plating of distal radius fractures and to evaluate surgeons' ability to detect intra-articular screw placement on static fluoroscopic images and rotational fluoroscopy. ⋯ Rotational fluoroscopy improves the surgeon's ability to detect intra-articular screw penetration during volar plating of the distal radius. No combination of imaging allowed detection of all intra-articular screws. A high level of suspicion for intra-articular screw penetration should be maintained during volar plating of distal radial fractures.
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The side-to-side (SS) tendon suture technique was designed to function as a repair that permits immediate postoperative activation and mobilization of a transferred muscle. This study was designed to test the strength and stiffness of the SS technique against a variation of the Pulvertaft (PT) repair technique. ⋯ The SS repair using a cross-stitch suture technique was significantly stronger and stiffer than the PT repair using a mattress suture technique. This suggests that using SS repairs could enable patients to load the repair soon after surgery. Ultimately, this should reduce the risk of developing adhesions and result in improved functional outcome and fewer complications in the acute postoperative period. Future work will address the specific mechanisms (eg, suture-throw technique and tendon-weave technique) that underlie the improved strength and stiffness of the SS repair.