The Journal of hand surgery
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Comparative Study
A biomechanical comparison of volar locked plating of intra-articular distal radius fractures: use of 4 versus 7 screws for distal fixation.
To determine whether the number of distal locking screws significantly affects stability of a cadaveric simulated distal radius fracture fixed with a volar locking plate. ⋯ The use of extra distal locking screws when fixing distal radius fractures increases expense and may increase the risk of complications, such as extensor tendon irritation or rupture.
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Randomized Controlled Trial Comparative Study
Open reduction internal fixation versus percutaneous pinning with external fixation of distal radius fractures: a prospective, randomized clinical trial.
The purpose of this randomized clinical trial was to investigate the functional outcomes of the surgical treatment of distal radius fractures, comparing treatment by external fixation and percutaneous pinning to open reduction and internal fixation (ORIF) using a plate. ⋯ The PRWE scores were significantly lower for patients treated with ORIF compared to those with external fixation, with the best outcomes observed with volar locking plates. These advantages were observed in the early postoperative period, and overall scores equalized at 1 year. A higher mean initial preoperative PRWE score was seen with external fixation, perhaps indicating a more severe initial injury. Given this difference, the interpretation of these results is not clear.
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Randomized Controlled Trial
Blood flow to the extensor carpi radialis brevis muscle following adrenaline infusion in patients with lateral epicondylitis.
Based on previous evidence of muscle fiber injury and decreased blood flow in the extensor carpi radialis brevis (ECRB) muscle in lateral epicondylitis (LE), we hypothesized that there would also be an abnormal (vasoconstrictive) vascular response to adrenaline in the ECRB muscle in LE. ⋯ In the ECRB muscle in LE, there is a shift in the balance of vasodilatory and vasoconstrictory influences of adrenaline, leading to vasoconstriction during low-dose adrenaline infusion. The adverse adrenaline effect is similar to what was previously observed after minor muscle injury. Whether the vasoregulatory change, by causing relative muscle ischemia, represents the primary etiology in LE or results from muscle injury cannot be determined, but it is likely to contribute to the development and continuation of chronic muscle pain in LE. New ways of thinking about the condition may be required, and pharmacological treatment might be an option to improve the blood supply and avoid further damage to the affected ECRB muscle-tendon unit.
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To compare the cartilage thickness of the third toe joints to the finger proximal interphalangeal (PIP) joints to assess the appropriateness of using third toe osteochondral grafts for finger PIP joint reconstruction. ⋯ There were significant differences in cartilage thickness between the third toe and the fingers in this study. However, fewer differences were observed with the third toe middle phalanx base cartilage thickness than with the third toe condyles in comparison to the fingers.
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Restoration of elbow flexion is an important goal in brachial plexus injuries. Double nerve transfers using fascicles from ulnar and median nerves have consistently produced good results without causing functional compromise to the donor nerve. According to conventional practice, these double nerve transfers are dependent on the careful isolation of ulnar and median nerve fascicles, which are responsible for wrist flexion, using a handheld nerve stimulator. Here we suggest that fascicular selection by nerve stimulation might not be a necessity when executing double nerve transfers for restoration of elbow flexion in brachial plexus injuries. ⋯ Double nerve transfer is a reliable technique for restoring elbow flexion in brachial plexus injuries. There is no advantage of using a nerve stimulator in selecting fascicles before performing the nerve transfer.